Low dose systemic thrombolytic therapy for treatment of deep venous thrombosis

Thrombolytic therapy is still not used widely for treatment of deep vein thrombosis despite its known efficacy. This reluctance to use it stems from worries about its hemorrhagic complications.

In a 4-year period 97 patients with deep vein thrombosis diagnosed by duplex study were enrolled into the study. Fifty patients received streptokinase as a bolus of 250,000 units followed by 100,000 units/hr with a maximum of 4,000,000 units and 47 patients received anticoagulation with heparin.

Minor hemorrhagic complications occurred in 2 patients (4%) in the thrombolytic therapy group. An improvement in the control duplex study was observed in 56% of the patients in the thrombolytic therapy group compared to 5% in the heparin group (p=0.000). The patients treated within 4 days of onset of symptoms had significantly higher success rates compared to those treated later (p=0.000). Higher success rates were obtained for those with either femoral vein or more distal venous thrombosis compared to those with iliac vein and vena cava thrombosis (p=0.007). These results show that systemic low dose streptokinase achieves significantly higher recanalization rates compared to heparin alone.

Hemorrhagic complications at these dose levels are within acceptable ranges. Low dose streptokinase regimen could be beneficial in patients who present within 4 days of femoral or more distal venous thrombosis.