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Use of Thrombolytic Drugs in Non-Coronary Disorders

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Summary

Clinical experience with thrombolytics in non-coronary disorders is limited to the plasminogen activators streptokinase, urokinase and alteplase; therapeutic trials with anistreplase (APSAC) are almost, and with saruplase completely, limited to acute myocardial infarction. In terms of thrombus clearance, thrombolytic drugs are superior to heparin in patients with recent deep vein thrombosis in the pelvis or lower limbs. In aggregate, thrombi younger than 8 days are lysed in approximately 60% of patients treated with streptokinase, urokinase or alteplase. The results of studies assessing the subsequent development of the postphlebitic syndrome are conflicting, but most suggest that thrombolytic therapy can reduce symptoms of chronic venous insufficiency.

Currently, the combination of systemic thrombolytic drugs followed by heparin is recommended for patients with acute major pulmonary embolism who are haemodynamically unstable. Streptokinase, urokinase and alteplase have all been shown to accelerate the lysis of pulmonary emboli and to decrease pulmonary vascular obstruction and pulmonary hypertension. Systemic venous or intrapulmonary infusions of alteplase offers the same benefit in terms of angiographic and haemodynamic improvement. A short infusion of 100mg alteplase over 2 hours seems to be superior to a 24-hour infusion of urokinase. None of the thrombolytic trials in pulmonary embolism have been large enough to demonstrate a reduction in mortality. It is now generally accepted that, unless contraindicated, thrombolytic therapy is the front-line treatment for patients with massive pulmonary embolism and major haemodynamic disturbance.

The local treatment of acute arterial occlusion in limb arteries results in rapid clearing of the artery in 67% of patients treated with streptokinase; the corresponding success rates for urokinase and alteplase are 81% and 88 to 94%, respectively. The main question appears to be the identification of patients in whom local thrombolysis is the treatment of choice, as opposed to established therapeutic modalities.

Thrombolytic treatment following a major ischaemic stroke is hazardous, although clinical improvement has been noted in a minority of patients with recanalised cerebral arteries. The safety and efficacy of thrombolytic treatment remains unproven for this indication, and its use must be restricted to experimental protocols. Thrombolytic treatment in retinal artery or vein occlusion has, in practice, been abandoned.

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References

  • Abbott WM, McCabe C, Maloney RD, Wirthlin LS. Embolism of the popliteal artery. Surgery, Gynecology and Obstetrics 159: 533–536, 1984

    PubMed  CAS  Google Scholar 

  • Albrechtsson U, Anderson J, Einarsson E, Eklöf B, Norgren L. Streptokinase treatment of deep venous thrombosis and the post-thrombotic syndrome. Archives of Surgery 116: 33–37, 1981

    PubMed  CAS  Google Scholar 

  • Amery A, Deloof W, Vermylen J, Verstraete M. Outcome of recent thromboembolic occlusions of limb arteries treated with streptokinase. British Medical Journal 9: 639–644, 1970

    Google Scholar 

  • Ammann J, Seiler H, Vogt B. Delayed arterial embolectomy: a plea for a more active surgical approach. British Journal of Surgery 63: 533–536, 1984

    Google Scholar 

  • Arnesen M, Hoirseth A, Ly B. Streptokinase or heparin in the treatment of deep vein thrombosis: follow-up results of a prospective study. Acta Medica Scandinavica 211: 65–68, 1982

    PubMed  CAS  Google Scholar 

  • Becker GJ, Rabe FE, Richmann BD, Holden HY, Yuner S, et al. Low dose fibrinolytic, therapy: results and new concepts. Radiology 148: 663–670, 1983

    PubMed  CAS  Google Scholar 

  • Been M, de Bono DP, Muir AL, Boulton FE, Fears R, et al. Clinical effect and kinetic properties of intravenous APSAC — anisoylated plasminogen — streptokinase activator complex (BRL 26921) in acute myocardial infarction. International Journal of Cardiology 11: 53–61, 1986

    PubMed  CAS  Google Scholar 

  • Belkin M, Belkin B, Buckman CA, Straub J, Lowe R. Intraarterial fibrinolytic therapy: efficacy of streptokinase vs urokinase. Archives of Surgery 121: 769–773, 1986

    PubMed  CAS  Google Scholar 

  • Berni GA, Bandyk DF, Zierler E, Thiele BL, Strandness DE. Streptokinase treatment for acute arterial occlusions. Annals of Surgery 198: 185–191, 1983

    PubMed  CAS  Google Scholar 

  • Bernstein M, Ross Fleming JF, Deck JHN. Cerebral hyperfusion after carotid endarterectomy: a cause of cerebral hemorrhage. Neurosurgery 15: 50–56, 1984

    PubMed  CAS  Google Scholar 

  • Bieger R, Boekhout-Mussert RJ, Hochmann F, Loeliger EA. Is streptokinase useful in the treatment of deep vein thrombosis? Acta Medica Scandinavica 199: 81–88, 1976

    PubMed  CAS  Google Scholar 

  • Brochier M, Fauchier JP, Griguer P, Raynaud P, Charbonnier B, et al. Le traitement thrombolytique de l’embolie pulmonaire (à propos de 80 cas traités par urokinase). Angéiologie 28: 299–312, 1976

    Google Scholar 

  • Brogden RN, Speight TM, Avery GS. Streptokinase: a review of its clinical pharmacology, mechanism of action and therapeutic uses. Drugs 5: 357–445, 1973

    PubMed  CAS  Google Scholar 

  • Brott T, Haley EC, Levy DE, Barsan WG, Armitage JL, et al. Very early therapy for cerebral infarction with tissue plasminogen activator (t-PA). Abstract no. 0563. Stroke 19(Suppl. 1): 133, 1988

    Google Scholar 

  • Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, et al. Thrombolysis in myocardial infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation 76: 142–154, 1987

    PubMed  CAS  Google Scholar 

  • Clarke DB, Abrams LD. Pulmonary embolectomy: a 25 year experience. Journal of Thoracic and Cardiovascular Surgery 92: 442–445, 1986

    PubMed  CAS  Google Scholar 

  • Collen D, Lijnen HR, Todd PA, Goa KL. Tissue-type plasminogen activator: a review of its pharmacology and therapeutic use as a thrombolytic agent. Drugs 38(3): 346–388, 1989

    PubMed  CAS  Google Scholar 

  • Come PC, Kim D, Parker A, Goldhaber SZ, Braunwald E, et al. Early reversal of right ventricular dysfunction in patients with acute pulmonary embolism after treatment with intravenous tissue plasminogen activator. Journal of the American College of Cardiology 10: 971–978, 1987

    PubMed  CAS  Google Scholar 

  • Common HH, Seaman AJ, Rösch J, Porter JM, Dotter CT. Deep vein thrombosis treated with streptokinase or heparin: follow-up of a randomized study. Angiology 27: 645–654, 1976

    PubMed  CAS  Google Scholar 

  • Conard J, Samama M, Milochevitch R, Horellou MH, Chabrun B, et al. Complications hémorragiques au cours de 98 traitements par la streptokinase: place de la surveillance biologique. Nouvelle Presse Médicale 8: 1319–1325, 1979

    PubMed  CAS  Google Scholar 

  • d’Angelo A, Mannucci PM. Outcome of treatment of deep-vein thrombosis with urokinase: relationship to dosage, duration of therapy, age of thrombus and laboratory changes. Thrombosis and Haemostasis 51: 236–239, 1984

    PubMed  Google Scholar 

  • Del Campo C. Pulmonary embolectomy: a review. Canadian Journal of Surgery 28: 111–113, 1985

    Google Scholar 

  • del Zoppo GJ, Ferbert A, Otis E, Brueckmann H, Hacke W, et al. Local intra-arterial fibrinolytic therapy in acute carotid territory stroke. Stroke 19: 307–313, 1988

    PubMed  Google Scholar 

  • Den Ottolander GJH, Creandyk A. Treatment of thrombosis of the central vein with streptokinase. Thrombosis et Diathesis Haemorrhagica 20: 415–419, 1968

    Google Scholar 

  • Dodson PM, Kritzinger EE. Management of retinal vein occlusion. British Medical Journal 295: 1434–1435, 1987

    PubMed  CAS  Google Scholar 

  • Dotter CT, Rosch J, Seaman AJ. Selective clot lysis with low dose streptokinase. Radiology 111: 31–37, 1974

    PubMed  CAS  Google Scholar 

  • Duckert F, Müller G, Nyman D, Benz A, Prinsender S, et al. Treatment of deep vein thrombosis with streptokinase. British Medical Journal 1: 479–481, 1975

    PubMed  CAS  Google Scholar 

  • Earnshaw JJ, Westby JC, Makin GS, Hopkinson BR. The systemic fibrinolytic effect of BRL 26921 during the treatment of acute peripheral arterial occlusions. Thrombosis and Haemostasis 55: 259–262, 1986

    PubMed  CAS  Google Scholar 

  • Eichlisberger R, Widmer MTh, Widmer LK, Zemp E. Spätfolgen nach Becken-Bein-Venenthrombose: Basler Erfahrungen. Vasa (Suppl. 20): 95–103, 1987

    Google Scholar 

  • Elliott MS, Immelman EJ, Jeffery P, Benatar SR, Funston MR, et al. A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: an interim report of a prospective trial. British Journal of Surgery 66: 838–843, 1979

    Google Scholar 

  • Fieschi C, Argentino C, Lenzi GL. Therapeutic window for pharmacologic treatment in acute focal cerebral ischaemia. Annals of the New York Academy of Science 522: 662–666, 1988

    CAS  Google Scholar 

  • Fiessinger JN, Aiach M, Lagneau P, Husson JM, Cormier JM, et al. Indications de la streptokinase dans les oblitérations artérielles de membres. Coeur et Médecine Interne 15: 453–459, 1976

    PubMed  CAS  Google Scholar 

  • Fine DG, Shepherd RF, Welch TJ. Thrombolytic therapy for superior vena cava syndrome. Lancet 1: 1200–1201, 1989

    PubMed  CAS  Google Scholar 

  • Fisher CM, Adams RD. Observations on brain embolism with special reference to hemorrhagic infarction. In Furlan AJ (Ed.) The heart and stroke, pp. 17–36, Springer-Verlag, Berlin, 1987

    Google Scholar 

  • François G, Charbonnier B, Raynaud P, Garnier LF, Griguer P, et al. Traitement de l’embolie pulmonaire aiguë par urokinase comparée à l’association plasminogène-urokinase: à propos de 67 cas. Archives des Maladies du Coeur 79: 435–442, 1986

    Google Scholar 

  • Gallus AS. The use of antithrombotic drugs in artery disease. In Chesterman CN (Ed.) Clinics in Haematology: thrombosis and the vessel wall, Vol. 15, No. 2, pp. 509–559, W.B. Saunders Company, London/Philadelphia/Toronto, 1986

    Google Scholar 

  • Goldhaber SZ, Buring JE, Lipnick RJ, Hennekens CH. Pooled analysis of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. American Journal of Medicine 76: 393–397, 1984

    PubMed  CAS  Google Scholar 

  • Goldhaber SZ, Kessler CM, Heit J, Markis J, Sharma GVRK, et al. Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 2: 293–298, 1988

    PubMed  CAS  Google Scholar 

  • Goldhaber SZ, Vaughan DE, Markis JE, Selwyn AP, Meyerovitz MF, et al. Acute pulmonary embolism treated with tissue plasminogen activator. Lancet 2: 886–889, 1986

    PubMed  CAS  Google Scholar 

  • Goldstein M. Hochdosierte Kurzzeitlyse mit Streptokinase bei massiver Lungembolie in der frühen postoperativen Phase. Anaesthesist 36: 239–241, 1987

    PubMed  CAS  Google Scholar 

  • Graor RA, Olin JW. Regional thrombolysis in peripheral artery occlusions. In Julian D et al. (Eds) Thrombolysis in cardiovascular disease, pp. 381–395, Marcel Dekker, Basel, New York, 1989

    Google Scholar 

  • Graor RA, Risius B, Denny K, Young JR, Beven EG, et al. Local thrombolysis in the treatment of thrombosed arteries, bypass grafts and arteriovenous fistulae. Journal of Vascular Surgery 2: 406–414, 1985

    PubMed  CAS  Google Scholar 

  • Graor RA, Risius B, Lucas FV, Young JR, Ruschhaupt WF, et al. Thrombolysis with recombinant human tissue-type plasminogen activator in patients with peripheral artery and bypass graft occlusions. Circulation 74(Suppl. 1): 1–15, 1986a

    Google Scholar 

  • Graor RA, Risius B, Young JR, Denny K, Beven EG, et al. Peripheral artery and bypass graft thrombolysis with recombinant human tissue-type plasminogen activator. Journal of Vascular Surgery 3: 115–124, 1986b

    PubMed  CAS  Google Scholar 

  • Graor RA, Risius B, Young JR, Geisinger MA, Zelch MG, et al. Low-dose streptokinase for selective thrombolysis: systemic effects and complications. Radiology 152: 35–39, 1984

    PubMed  CAS  Google Scholar 

  • Gray HH, Morgan JM, Paneth M, Miller GAH. Pulmonary embolectomy for acute massive pulmonary embolism: an analysis of 71 cases. British Heart Journal 60: 196–200, 1988

    PubMed  CAS  Google Scholar 

  • Griguer P, Charbonnier B, Latour F, Fauchier JP, Brochier M. Plasminogen and moderate doses of urokinase in the treatment of acute pulmonary embolism. Angiology 30: 1–12, 1979

    PubMed  CAS  Google Scholar 

  • Groupe de Recherche Urokinase-Embolie Pulmonaire. Etude multicentrique sur deux protocols d’urokinase dans l’embolie pulmonaire grave. Archives des Maladies du Coeur 77: 773–781, 1984

    Google Scholar 

  • Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet 1: 397–402, 1986

    Google Scholar 

  • Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI). Long-term effects of intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study. Lancet 2: 871–874, 1987

    Google Scholar 

  • Hacke W, Zeumer H, Ferbert A, Bruckmann H, del Zoppo GJ. Intraarterial fibrinolytic therapy improves outcome in patients with acute vertebrobasilar occlusive disease. Stroke 19: 1216–1222, 1988

    PubMed  CAS  Google Scholar 

  • Hasler K, Magdalinski D. Urokinase therapy of deep vein thrombosis. Münchener Medizinische Wochenschrift 126: 122–124, 1984

    PubMed  CAS  Google Scholar 

  • Henze T, Boerr A, Tebbe U, Romatowski J. Lysis of basilar artery occlusion with tissue plasminogen activator. Lancet 2: 1391, 1987

    PubMed  CAS  Google Scholar 

  • Hess H, Ingrisch H, Meitaschk A, Rath H. Local low-dose thrombolytic therapy of peripheral arterial occlusions. New England Journal of Medicine 307: 1627–1630, 1982

    PubMed  CAS  Google Scholar 

  • Immelman EJ, Jeffery PC, Clifford P, McIrvine A, Martell RW, et al. Streptokinase-plasminogen activator complex (BRL 26921) in the treatment of venous thromboembolism. Thrombosis Research 49: 635–642, 1988

    PubMed  CAS  Google Scholar 

  • ISAM Study Group. A prospective trial of intravenous streptokinase in acute myocardial infarction (ISAM): mortality, morbidity and infarct size at 21 days. New England Journal of Medicine 314: 1465–1471, 1986

    Google Scholar 

  • ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 2: 349–360, 1988

    Google Scholar 

  • Johansson E, Ericson K, Zetterquist S. Streptokinase treatment of deep venous thrombosis of the lower extremity. Acta Medica Scandinavica 199: 89–94, 1976

    PubMed  CAS  Google Scholar 

  • Johnson AJ, McCarty WR. The lysis of artificially induced intravascular clots in man by intravenous infusions of streptokinase. Journal of Clinical Investigation 38: 1627–1643, 1959

    PubMed  CAS  Google Scholar 

  • Jørgensen B, Tønnesen KH, Bülow J, Nielsen JD, Jørgensen M, et al. Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator. Lancet 1: 1106–1108, 1989

    PubMed  Google Scholar 

  • Juhan J, Calas MF, Buonocore M, Mathieu P, Isnard G, et al. Modifications in coagulation parameters induced by treatment associating urokinase (2,000 U CTA/kg/h) with heparin. Thrombosis and Haemostasis 42: 945–954, 1979

    PubMed  CAS  Google Scholar 

  • Kakkar VV, Flanc C, Howe CT, O’Shea M, Flute PT. Treatment of deep vein thrombosis: a trial of heparin, streptokinase, and Arvin. British Medical Journal 1: 806–810, 1969a

    PubMed  CAS  Google Scholar 

  • Kakkar VV, Howe CT, Law JS, Flane C. Late results of treatment of deep vein thrombosis. British Medical Journal 1: 810–811, 1969b

    PubMed  CAS  Google Scholar 

  • Kakkar VV, Lawrence D. Hemodynamic and clinical assessment after therapy for acute vein thrombosis: a prospective study. American Journal of Surgery 150: 54–63, 1985

    PubMed  CAS  Google Scholar 

  • Kakkar VV, Paes TRF, Murray WJG. Does thrombolytic treatment prevent the post-phlebitic syndrome? Abstract no. 5222. Proceedings of the 2nd International Vascular Symposium, London, 1986

  • Kakkasseril J, Cranley JJ, Arbaugh JJ, Roedersheimer R, Welling RE. Efficacy of low dose streptokinase in acute arterial occlusion and graft thrombosis. Archives of Surgery 120: 427–429, 1985

    PubMed  CAS  Google Scholar 

  • Kasper W, Meinertz T, Wollschlaeger H, Bonzel T, Wolff P, et al. Coronary thrombolysis during acute myocardial infarction by intravenous BRL 26921, a new anisoylated plasminogen streptokinase activator complex. American Journal of Cardiology 58: 418–421, 1986

    PubMed  CAS  Google Scholar 

  • Katzen BT, Van Breda A. Low dose streptokinase in the treatment of arterial occlusions. American Journal of Radiology 136: 1171–1178, 1981

    CAS  Google Scholar 

  • Katzen BT, Edwards KC, Albert AS, et al. Low dose fibrinolysis in peripheral vascular disease. Journal of Vascular Surgery 1: 718–722, 1984

    PubMed  CAS  Google Scholar 

  • Koch H-U. Lysetherapie tiefer Phlebotrombosen mit ultrahochdosierter Streptokinase gefolgt von konventionell dosierter Urokinase. Die Medizinische Welt 39: 245–250, 1988

    Google Scholar 

  • Kohner EM, Pettit JE, Hamilton AM, Bulpitt CJ, Dollery CT. Streptokinase in central retinal occlusion: a controlled clinical trial. British Medical Journal 1: 550–553, 1976

    PubMed  CAS  Google Scholar 

  • Koltun WA, Gardiner GA, Harrington DP, Couch NP, Mannick JA, et al. Thrombolysis in the treatment of peripheral arterial vascular occlusions. Archives of Surgery 122: 901–905, 1987

    PubMed  CAS  Google Scholar 

  • Koudstaal PJ, Stibbe J, Vermeulen M. Fatal ischemic brain oedema after early thrombolysis with tissue plasminogen activator in acute stroke. British Medical Journal 297: 1571–1574, 1988

    PubMed  CAS  Google Scholar 

  • Krüger P. Lysebehandlung mit ultra hoher Streptokinase (UHSK) bei Phlebothrombosen der unteren Extrimitäten. Herz/Kreislauf 20: 196–202, 1988

    Google Scholar 

  • Kwaan H. Thromboembolic disorders of the eye in thrombolytic therapy. In Comerota AJ (Ed.) Thrombolytic therapy, pp. 153–163, Grune and Stratton, New York, 1988

    Google Scholar 

  • Lammer J, Pilger E, Justich E, Neumayer K, Schreyer H. Fibrinolysis in chronic arteriosclerotic occlusions: intrathrombotic injections of streptokinase. Radiology 157: 45–50, 1985

    PubMed  CAS  Google Scholar 

  • Lang EK. Streptokinase therapy: complications of intra-arterial use. Radiology 154: 75–77, 1985

    PubMed  CAS  Google Scholar 

  • Lassen NA, Astrup J. Ischemic penumbra. In Wood JH (Ed.) Cerebral blood flow: physiologic and clinical aspects, pp. 458–466, McGraw-Hill Inc., New York, 1987

    Google Scholar 

  • Lechler E, Meyer-Börnecke D, Winter UJ, Schulz V. Intermittent high dosage scheme of streptokinase/urokinase in fibrinolytic therapy. Thrombosis and Haemostasis 54: 272, 1985

    Google Scholar 

  • Leeper KV, Popovich J, Lesser BA, Adams D, Froelich JW, et al. Treatment of massive acute pulmonary embolism: the use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin. Chest 93: 234–240, 1988

    PubMed  Google Scholar 

  • Magnani B, for the PAIMS Investigators. Plasminogen-Activator-Italian Multicenter-Study (PAIMS): comparison of intravenous recombinant single-chain human tissue-type plasminogen activator (rt-PA) with intravenous streptokinase in acute myocardial infarction. Journal of the American College of Cardiology 13: 19–26, 1989

    PubMed  CAS  Google Scholar 

  • Mannucci PM, Thrombolytic therapy of acute deep vein thrombosis of the lower limbs: choices, indications and limits. Ricerca in Clinica e in Laboratorio 14: 593–599, 1984

    PubMed  CAS  Google Scholar 

  • Marder VJ, Rothbard RL, Fitzpatrick PG, Francis CW. Rapid lysis of coronary artery thrombi with anisoylated plasminogen streptokinase activator complex: treatment by bolus intravenous injection. Annals of Internal Medicine 104: 304–310, 1986

    PubMed  CAS  Google Scholar 

  • Martin M. Thrombolytic therapy in arterial thromboembolism. Progress in Cardiovascular Disease 21: 351–374, 1979

    CAS  Google Scholar 

  • Martin M, Fiebach BJO. Die Streptokinase-Behandlung peripherer Arterien und Venenverschlüsse unter besonderer Berücksichtigung der ultrahohen Dosierung, Verlag H Huber, Bern-Stuttgart-Toronto, 1985

  • Martin M, Schoop W, Zeitler E. Streptokinase in chronic arterial occlusive disease. Journal of the American Medical Association 211: 1169–1173, 1970

    PubMed  CAS  Google Scholar 

  • Mathey DG, Schofer J, Sheehan FH, Becher H, Tilsner V. Intravenous urokinase in acute myocardial infarction. American Journal of Cardiology 55: 878–882, 1985

    PubMed  CAS  Google Scholar 

  • McNamara TO. Role of thrombolysis in peripheral arterial occlusion. American Journal of Cardiology 83(Suppl. 2A): 6–10, 1987

    CAS  Google Scholar 

  • McNamara TO, Bomberger RA. Factors affecting initial and 6 months patency rates after intraarterial thrombolysis with high dose urokinase. American Journal of Surgery 152: 709–712, 1986

    PubMed  CAS  Google Scholar 

  • McNamara TO, Fischer JR. Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase. American Journal of Radiology 144: 769–775, 1985

    CAS  Google Scholar 

  • Metzler de Höhmann-Weigelin. Fibrinolyse und antikoagulantien Therapie bei retinalen Venenverschlüssen. Die Medizinische Verlagsgesellschaft, Marburg/Lahn, 1977

    Google Scholar 

  • Meyer G, Sors H, Stern M, Charbonnier B, Brochier ML. Thrombolysis in acute pulmonary embolism. In Julian D et al. (Eds) Thrombolysis in cardiovascular disease, pp. 337–360, Marcel Dekker Inc., Basel/New York, 1989

    Google Scholar 

  • Miller GAH, Sutton GC, Kerr IH, Gibson RV, Honey M. Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. British Medical Journal 2: 681–684, 1971

    PubMed  CAS  Google Scholar 

  • Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, et al. The Harvard Cooperative Stroke Registry: a prospective registry. Neurology 28: 754–762, 1978

    PubMed  CAS  Google Scholar 

  • Monk JP, Heel RC. Anisoylated plasminogen streptokinase activator complex (APSAC). A review of its mechanism of action, clinical pharmacology and therapeutic use in acute myocardial infarction. Drugs 34: 25–49, 1987

    PubMed  CAS  Google Scholar 

  • Mori E, Tabuchi M, Yoshida T, Yamadori A. Intracarotid urokinase with thromboembolic occlusions of the middle cerebral artery. Stroke 19: 802–812, 1988

    PubMed  CAS  Google Scholar 

  • Mori KW, Bookstein JJ, Heeney DJ, Bardin JA, Donnelly KJ, et al. Selective streptokinase infusion: clinical and laboratory correlates. Radiology 148: 677–682, 1983

    PubMed  CAS  Google Scholar 

  • Moss JG, Boulton FE, Ruckley CV, Buist TAS. Catheter-induced superior vena cava thrombosis: lysis with streptokinase and APSAC (Anisoylated Plasminogen Streptokinase Activator Complex BRL 26921). Fibrinolysis 1: 231–235, 1987

    Google Scholar 

  • Niessner H. Kontinuierliche oder intermitterende Urokinasetherapie? In Trübestein (Ed.) Urokinase therapy, pp. 43–54, F.K. Schattauer Verlag, 1981

    Google Scholar 

  • Niessner H, Lechner K, Thaler E. Laboratory and clinical evaluation of five urokinase schemes in acute and subacute deep vein thrombosis: a non-randomized study in 34 patients. In Mannucci & d’Angelo (Eds) Urokinase: basic and clinical aspects, pp. 111–121, Academic Press, New York, 1982

    Google Scholar 

  • Pernes JM, de Almeida Augusto M, Vitoux JF, Raynaud A, Fiessinger JM, et al. Local thrombolysis in peripheral arteries and bypass grafts. Journal of Vascular Surgery 6: 372–378, 1985

    Google Scholar 

  • Petitpretz P, Simmoneau G, Cerrina J, Musset D, Dreyfus M, et al. Effects of single bolus of urokinase in patients with life-threatening pulmonary emboli: a descriptive trial. Circulation 70: 861–866, 1984

    PubMed  CAS  Google Scholar 

  • Porter JM, Seaman AJ, Common HH, Rösch J, Eidemiller LR, et al. Comparison of heparin and streptokinase in the treatment of venous thrombosis. American Journal of Surgery 41: 511–519, 1975

    CAS  Google Scholar 

  • PRIMI Trial Study Group. Randomised double-blind trial of recombinant pro-urokinase against streptokinase in acute myocardial infarction. Lancet 1: 863–867, 1989

    Google Scholar 

  • Reim M, Bertram B, Wolf S. Behandlungsversuche der Zentralvenenthrombose der Netzhaut mit Plasminogen-Aktivator (rt-PA). Klinische Wochenschrift 66(Suppl. XII): 143–149, 1988

    PubMed  Google Scholar 

  • Ricotta JJ, Green RM, DeWeese JA. Use and limitations of thrombolytic therapy in the treatment of peripheral arterial ischemia: results of a multi-institutional questionnaire. Journal of Vascular Surgery 6: 46–50, 1987

    Google Scholar 

  • Robertson BR, Nilsson IM, Nylander G. Value of streptokinase and heparin in treatment of acute deep venous thrombosis: a coded investigation. Acta Chirurgica Scandinavica 134: 203–208, 1968

    PubMed  CAS  Google Scholar 

  • Robertson BR, Nilsson IM, Nylander G. Thrombolytic effect of streptokinase as evaluated by phlebography of deep venous thrombi of the leg. Acta Chirurgica Scandinavica 136: 173–180, 1970

    PubMed  CAS  Google Scholar 

  • Rösch J, Dotter CT, Seaman JH, Porter JM, Common HH. Healing of deep venous thrombosis: venographic findings in a randomized study comparing streptokinase and heparin. American Journal of Roentgenology 127: 553–558, 1976

    PubMed  Google Scholar 

  • Ruckley CV, Boulton FE, Redhead D. The treatment of venous thrombosis of the upper and lower limbs with ‘APSAC’ (p-anisoylated streptokinase-plasminogen complex). European Journal of Vascular Surgery 1: 107–112, 1987

    PubMed  CAS  Google Scholar 

  • Sasahara AA, Henkin J, Janicki RS. Urokinase versus tissue plasminogen activator in pulmonary embolism. Lancet 2: 691, 1988

    Google Scholar 

  • Schöffel G, Zimmerman R, Harenberg J, Mörl H. Blood coagulation changes during effective thrombolysis, using urokinase and heparin. Thrombosis Research 25: 11–21, 1982

    PubMed  Google Scholar 

  • Schulman S, Lockner D, Granqvist S, Bratt G, Paul C, et al. A comparative randomized trial of low-dose versus high-dose streptokinase in deep vein thrombosis of the thigh. Thrombosis and Haemostasis 51: 261–265, 1984

    PubMed  CAS  Google Scholar 

  • Serradimigni A, Mathieu P, Sainsous J, Chiche G, Egre A. Traitement médical des thromboses veineuses ilio-caves. Archives des Maladies du Coeur 3: 347–356, 1981

    Google Scholar 

  • Sharma GVRK, Burleson VA, Sasahara AA. Effect of thrombolytic therapy on pulmonary capillary blood volume in patients with pulmonary embolism. New England Journal of Medicine 303: 842–845, 1980

    PubMed  CAS  Google Scholar 

  • Sharma GVRK, O’Connell DJ, Blelko JS, Sasahara AA. Thrombolytic therapy in deep vein thrombosis. In Paoletti & Sherry (Eds) Thrombosis and urokinase, pp. 181–189, Academic Press, New York, 1977

    Google Scholar 

  • Sherry S, Bell WR, Duckert FH, Fletcher P, Gurewich V, et al. Thrombolytic therapy in thrombosis: a national institutes of health consensus development conference. Annals of Internal Medicine 93: 141–144, 1980

    Google Scholar 

  • Sloan MA, del Zoppo GJ, Brott TG. Thrombolysis and stroke. In Julian D et al. (Eds) Thrombolysis in cardiovascular disease, pp. 361–380, Marcel Dekker Inc., Basel/New York, 1989

    Google Scholar 

  • Stern M, Meyer G, Sors H. Urokinase versus tissue plasminogen activator in pulmonary embolism. Lancet 2: 691–692, 1988

    Google Scholar 

  • Stewart A, Mayne EE. Rapid resolution of subclavian vein thrombosis by tissue plasminogen activator. Lancet 1: 890, 1988

    PubMed  CAS  Google Scholar 

  • Tennant SN, Dixon J, Venable TC, Page HG, Roach A, et al. Intracoronary thrombolysis in patients with acute myocardial infarction: comparison of the efficacy of urokinase and streptokinase. Circulation 69: 756–760, 1984

    PubMed  CAS  Google Scholar 

  • Tesi M, Carini A, Mirchiani R, Bronchi GF. Thrombolytic therapy with urokinase in deep venous thrombosis. In Trübestein & Etzel (Eds) Fibrinolytic therapy, pp. 249–253, Schattauer, Stuttgart, 1983

    Google Scholar 

  • The Urokinase Pulmonary Embolism Trial (UPET): a national cooperative study. Circulation 47(Suppl. 2): 1–108, 1973

    Google Scholar 

  • Theiss W, Bauman G, Klein G. Fibrinolytische Behandlung tiefer Venenthrombosen mit Streptokinase in ultrahoher Dosierung. Deutsche Medizinische Wochenschrift 112: 668–674, 1987

    PubMed  CAS  Google Scholar 

  • TIMI Study Group. The thrombolysis in myocardial infarction (TIMI) trial: phase I results. New England Journal of Medicine 312: 932–936, 1985

    Google Scholar 

  • Totty WG, Gilula LA, McClennan BL. Low-dose intravascular fibrinolytic therapy. Radiology 143: 59–69, 1982

    PubMed  CAS  Google Scholar 

  • Tsapogas MJ, Peabody RA, Wu KT, Karmody AM, Devaraj KT, et al. Controlled study of thrombolytic therapy in deep vein thrombosis. Surgery 74: 973–984, 1973

    PubMed  CAS  Google Scholar 

  • t-PA in Acute Stroke Study Group. An open multicenter study of the safety and efficacy of various doses of rt-PA in patients with acute stroke: preliminary results. Stroke 19(Suppl. 1): 134, 1988

    Google Scholar 

  • Trübestein G. Can thrombolytics prevent post-phlebitic syndrome and thromboembolic disease? Haemostasis 3(Suppl. 6): 38–50, 1986

    Google Scholar 

  • Trübestein G, Brecht TH, Ludwig M, Brecht G, Etzel F. Fibrinolytische Therapie mit Streptokinase and Urokinase bei tiefer Venenthrombose. In Trübestein & Etzel (Eds) Fibrinolytic therapy, pp. 193–201, Schattauer, Stuttgart, 1983

    Google Scholar 

  • Trübestein G, Brecht TH, Ludwig M, Etzel F. Experience with urokinase therapy in the treatment of fresh and older deep vein thromboses. In Trübestein G (Ed.) Urokinase therapy, pp. 67–89, F.K. Schattauer Verlag, 1981

    Google Scholar 

  • Trübestein G, Trübestein R, Ludwig M, Brecht Th, Harder Th. Fibrinolytic therapy with streptokinase and urokinase in deep vein thrombosis. Vascular Medicine 3: 72–78, 1985

    Google Scholar 

  • Turpie AGG. Thrombolytic therapy in venous thromboembolism. In Sobel B et al. (Eds) Tissue plasminogen activator in thrombolytic therapy, pp. 131–146, Marcel Dekker Inc., Basel, New York, 1987

    Google Scholar 

  • Turpie AGG. Thrombolysis in deep vein thrombosis. In Julian D et al. (Eds) Thrombolysis in cardiovascular disease, pp. 397–408, Marcel Dekker Inc., Basel/New York, 1989

    Google Scholar 

  • Urokinase-Streptokinase Embolism Trial: phase II results: a national cooperative study. Journal of the American Medical Association 229: 1606–1613, 1974

    Google Scholar 

  • Van Breda A, Katzen BT, Deutsch AS. Urokinase vs streptokinase in local thrombolysis. Radiology 165: 109–111, 1987

    PubMed  Google Scholar 

  • Van Breda A, Robison JC, Feldman L, Katzen BT, Deutsch AS. Local thrombolysis in the treatment of arterial graft occlusions. Journal of Vascular Surgery 1: 103–112, 1984

    PubMed  Google Scholar 

  • van de Loo JCW, Kriessmann A, Trübestein G, Knoch K, de Swart CAM, et al. Controlled multicenter pilot study of urokinase-heparin and streptokinase in deep vein thrombosis. Thrombosis and Haemostasis 50: 660–663, 1983

    PubMed  Google Scholar 

  • Van de Werf, Arnold AE, for the European Cooperative Study Group for recombinant tissue type plasminogen activator. Intravenous tissue plasminogen activator and size of infarct, left ventricular function, and survival in acute myocardial infarction. British Medical Journal 297: 1374–1378, 1988

    PubMed  Google Scholar 

  • Van de Werf F, Nobuhara M, Collen D. Coronary thrombolysis with human single chain urokinase-type plasminogen activator (pro-urokinase) in patients with acute myocardial infarction. Annals of Internal Medicine 104: 345–348, 1986

    PubMed  Google Scholar 

  • Verhaeghe R, Besse P, Bounameaux H, Marbet GA. Multicenter pilot study of the efficacy and safety of systemic rt-PA administration in the treatment of deep vein thrombosis of the lower extremities and/or pelvis. Thrombosis Research 55: 5–12, 1989

    PubMed  CAS  Google Scholar 

  • Verstraete M. The pros and cons of thrombolytic treatment in acute myocardial infarction. Circulation 55: 5–12, 1989

    Google Scholar 

  • Verstraete M, Bernard R, Bory M, Brower RW, Collen D, et al. Randomised trial of intravenous recombinant tissue-type plasminogen activator versus intravenous streptokinase in acute myocardial infarction. Lancet 1: 842–847, 1985

    PubMed  CAS  Google Scholar 

  • Verstraete M, Collen D. Thrombolytic properties of t-PA in experimental venous occlusion and in patients with venous thrombosis. In Collen D et al. (Eds) Thrombolysis: biological and therapeutic properties of new thrombolytic agents, pp. 49–60, Churchill Livingstone, Edinburgh, 1985

    Google Scholar 

  • Verstraete M, Hess H, Mahler F, Mietaschk A, Roth FJ, et al. Femoro-popliteal artery thrombolysis with intra-arterial infusion of recombinant tissue-type plasminogen activator: report of a pilot trial. European Journal of Vascular Surgery 2: 155–159, 1988b

    PubMed  CAS  Google Scholar 

  • Verstraete M, Miller GAH, Bounameaux H, Charbonnier B, Colle JP, et al. Intravenous and intrapulmonary recombinant tissue-type plasminogen activator in the treatment of acute massive pulmonary embolism. Circulation 27: 353–360, 1988a

    Google Scholar 

  • Verstraete M, Vermylen J, Amery J, Vermylen C. Thrombolytic therapy with streptokinase using a standard dosage scheme. British Medical Journal 1: 454–456, 1966

    PubMed  CAS  Google Scholar 

  • Verstraete M, Vermylen J, Donati MB. The effect of streptokinase infusion on chronic arterial occlusions and stenoses. Annals of Internal Medicine 74: 377–382, 1971

    PubMed  CAS  Google Scholar 

  • Weimar W, Stibbe J, van Seyen AJ, Billiau A, de Somer P, et al. Specific lysis of an iliofemoral thrombus by administration of extrinsic (‘tissue-type’) plasminogen activator. Lancet 2: 1018–1020, 1981

    PubMed  CAS  Google Scholar 

  • White HD, Norris RM, Brown MA, Takayama M, Maslowski A, et al. Effect of intravenous streptokinase in left ventricular function and early survival after acute myocardial infarction. New England Journal of Medicine 317: 850–855, 1987

    PubMed  CAS  Google Scholar 

  • Widmer LK, Brandenberg E, Widmer MT, Schmitt HE, Duckert F, et al. Late sequelae of deep vein thrombosis. International Angiology 1: 31–37, 1982

    Google Scholar 

  • Wilcox RG, Olsson CG, Skene AM, von der Lippe G, Jensen G, et al. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Lancet 2: 525–530, 1988

    PubMed  CAS  Google Scholar 

  • Wolfson RH, Kumpe DA, Rutherford RB. Role of intraarterial streptokinase in the treatment of arterial thromboembolism. Archives of Surgery 119: 697–702, 1984

    PubMed  CAS  Google Scholar 

  • Zeumer H. Survey of progress: vascular recanalizing techniques in interventional neuroradiology. Journal of Neurology 231: 287–294, 1985

    PubMed  CAS  Google Scholar 

  • Zimmermann R, Horn A, Harenberg J, Diehm C, Müller-Bühl U, et al. Thrombolysetherapie der tiefen venösen Thrombose mit rt-PA. Klinische Wochenschrift 66(Suppl. XII): 137–142, 1988

    PubMed  Google Scholar 

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  1. Center for Thrombosis and Vascular Research, University of Leuven, Campus Gasthuisberg, Gebouw Onderwijs en Navorsing, Herestraat 49, B-3000, Leuven, Belgium

    Marc Verstraete

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Verstraete, M. Use of Thrombolytic Drugs in Non-Coronary Disorders. Drugs 38, 801–821 (1989). https://doi.org/10.2165/00003495-198938050-00006

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