Urokinase versus streptokinase in local thrombolysis

In a retrospective analysis, the efficacy of lysis, the degree of systemic thrombolytic effect, and the rate of complications during local thrombolytic therapy with either streptokinase (SK) or urokinase (UK) were compared in 47 patients. There were 24 infusions of each agent; one patient in the UK group received two infusions. The overall efficacy of lysis was better in the UK-treated group (80% vs. 63%). The UK group had a lower frequency of systemic thrombolytic effect and of bleeding complications. SK antibody titers were measured in all patients who received infusions. Patients with high titers who were treated with SK responded poorly (20% lysis); patients with low titers responded at a rate equal to that of UK-treated patients. Three patients with high titers of SK antibodies did not respond to SK, but subsequent successful lysis did occur with UK. In conclusion, UK is believed to be preferable to SK for local thrombolytic therapy due to increased efficacy of lysis and decreased rate of systemic fibrinolytic effect and bleeding complications.