Skip to main content
Log in

Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript


To test the efficacy of thrombolytic therapy in massive pulmonary embolism, we conducted a prospective randomized controlled trial. Eight patients were randomized to receive either 1,500,000 IU of streptokinase in 1 hour through a peripheral vein followed by heparin or heparin alone. All patients had major risk factors for deep vein thrombosis (DVT) and were considered to have high clinical suspicion for pulmonary embolism (PE). At baseline all patients had a similar degree of systemic arterial hypotension, pulmonary arterial hypertension, and right ventricular dysfunction. The time of onset of cardiogenic shock in both groups was comparable (2.25 ±0.5 hours in the streptokinase group and 1.75 ±0.96 hours in the heparin group). The four patients who were randomized to streptokinase improved in the first hour after treatment, survived, and in 2 years of follow-up are without pulmonary arterial hypertension. All four patients treated with heparin alone died from 1 to 3 hours after arrival at the emergency room (p=0.02). Post-thrombolytic therapy the diagnosis of PE was sustained in the streptokinase group by high probability V/Q lung scans and proven DVT. A necropsy study performed in three patients in the heparin group showed massive pulmonary embolism and right ventricular myocardial infarction, without significant coronary arterial obstruction. The results indicate that thrombolytic therapy reduces the mortality rate of massive acute pulmonary embolism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


  1. Levine MN, Goldhaber SZ, Califf RN, Gore JM, Hirsh J. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism.Chest 1992;102:364S-373S.

    PubMed  Google Scholar 

  2. Jerjes-Sanchez C, Ramirez-Rivera A, Pimentel GM, Arriaga R. Dosis altas e infusion rapida de estreptoquinasa para el trata miento de tromboembolia pulmonar masiva.Arch Inst Cardiol Mex 1993;63:227–234.

    PubMed  Google Scholar 

  3. The PIOPED Investigators. Value of the ventilation/perfusion scan in acute pulmonary embolism: Results of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED).JAMA 1990;262:2753–2759.

    Google Scholar 

  4. Come PC. Echocardiographic evaluation of pulmonary embolism and its response to therapeutic interventions.Chest 1992;101:151S-162S.

    PubMed  Google Scholar 

  5. Hull RD, Hirsh J, Carter CJ, et al. Pulmonary angiography, ventilation lung scanning and venography for clinically suspected pulmonary embolism with abnormal perfusion lung scan.Ann Intern Med 1983;98:891–899.

    PubMed  Google Scholar 

  6. Actams NJE III, Siegel BA, Goldstein UA, Jaffe AS. Elevation of CK-MB following pulmonary embolism. A manifestation of occult right ventricular infarction.Chest 1992;101:1203–1206.

    PubMed  Google Scholar 

  7. Goldhaber SZ, Haire WD, Feldstein ML, et al. Alteplase versus heparin in acute pulmonary embolism; randomised trial assessing right-ventricular function and pulmonary perfusion.Lancet 1993;341:507–511.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

About this article

Cite this article

Jerjes-Sanchez, C., Ramírez-Rivera, A., de Lourdes García, M. et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: A randomized controlled trial. J Thromb Thrombol 2, 227–229 (1995).

Download citation

  • Issue Date:

  • DOI:

Key words