[Medical treatment of ilio-caval venous thrombosis]

120 patients with ilio-caval thrombosis were managed medically. 55 patients were given heparin (5 mg/Kg/day for 15 days), 50 patients received streptokinase (loading dose 250,000 u; maintenance dose 100,000 m/h for 48 hours) and 15 patients had urokinase (112,500 u/h for 44 hours). Thrombolytic therapy was prescribed, in the absence of contraindications, for patients below 70 year of age: other patients were treated with heparin. The results were assessed by venography performed before and after treatment: success was defined as the complete disappearance of the thrombus of disobliteration of the ilio-caval axis. The overall success rate was 32%, with 68% failures. Success was higher with streptokinase (50%) than with heparin (20%) or urokinase (13%). The site, extension ans aetiology of the thrombosis did not affect the results. On the other hand, two other factors seemed to play an important role: - the duration of thrombosis: this only affected the streptokinase group; 23 of the 25 successes were obtained in patients treated before the tenth day. The results were unaffected by the duration of the thrombosis in the heparin group; - the biological effectiveness of therapy: 7 out of the 11 successes in the heparin group had been constantly well anticoagulated; there were only 4 successes out of 38 patients in whom the biological effectiveness had been intermittent. There were 21 successes out of 32 patients treated by streptokinase with serum fibrin levels of less than 1 g. There were only 4 successes in the 18 other cases. The incidence of haemorrhage was identical in the 3 groups. Embolism was slightly commoner in the streptokinase (3) than in the heparin group (2).