Streptokinase treatment of acute arterial occlusion

In selected cases, streptokinase, a thrombolytic agent, is an effective alternative to surgical intervention for the treatment of acute arterial occlusions. Successful thrombolysis was achieved in 12 of 16 arterial occlusions (75%) following the intra-arterial infusion of streptokinase at a dosage of 5,000 U per hour. Neither the etiology nor the duration of the occlusions influenced the ability to achieve effective thrombolysis. The major limitation of the technique was the time required to ensure complete thrombolysis (37.5 +/- 17.5 hours). Despite the localized infusion of streptokinase proximal to the arterial obstruction at low dosages, hypofibrinogenemia (100 mg/dl) occurred in five patients and four patients developed a bleeding complication. The use of concomitant heparin (300-500 U per hour) increased the risk of bleeding without increasing thrombolytic potential. Streptokinase treatment of acute arterial occlusions should be used selectively depending on the degree of ischemia, the etiology of the obstruction, and the clinical status of the patient.