Streptokinase vs heparin for deep venous thrombosis. Can lytic therapy be justified?

Lytic therapy, most notably streptokinase, holds great promise in the treatment of acute deep venous thrombosis. In 19 published trials, this form of lytic therapy has been shown to be associated with greater venous valvular and venous patency preservation, implying better short-term and long-term outcome. Unfortunately, closer examination of the data reveals several flaws, including overreliance on venogram data and lack of adequate long-term follow-up. Streptokinase, as well as other forms of lytic therapy, has not gained widespread acceptance in the treatment of acute deep venous thrombosis, and, until better data become available, such reluctance seems justified.