TY - JOUR
T1 - Treatment of massive acute pulmonary embolism
T2 - The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin
AU - Leeper, K. V.
AU - Popovich, J.
AU - Lesser, B. A.
AU - Adams, D.
AU - Froelich, J. W.
AU - Burke, M. W.
AU - Shetty, P. C.
AU - Thrall, J. H.
AU - Stein, P. D.
PY - 1988
Y1 - 1988
N2 - The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase, 10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 ± 2 to 2 ± 1 after 12-24 hours (p<.01). No change was shown in the contralateral lung. The angiographic index of severity score in the infused lung decreased from 16±1 to 9±4 (p<.01). The partial pressure of oxygen in arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.
AB - The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase, 10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 ± 2 to 2 ± 1 after 12-24 hours (p<.01). No change was shown in the contralateral lung. The angiographic index of severity score in the infused lung decreased from 16±1 to 9±4 (p<.01). The partial pressure of oxygen in arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.
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U2 - 10.1378/chest.93.2.234
DO - 10.1378/chest.93.2.234
M3 - Article
C2 - 3338289
AN - SCOPUS:0023864603
SN - 0012-3692
VL - 93
SP - 234
EP - 240
JO - CHEST
JF - CHEST
IS - 2
ER -