Selective streptokinase infusion: clinical and laboratory correlates

Selective intra-arterial infusions of streptokinase (SK) were made in 50 arteries of 45 patients with a variety of acute thromboembolic conditions. The most common regimen was 5,000 units of SK/hour for 24 to 48 hours with a simultaneous heparin infusion of 250 to 500 units/hour. Significant lysis occurred in 80% of cases, with 74% of the patients benefiting clinically. Minor bleeding, usually from puncture sites, occurred in 30% of the patients. Major hemorrhages, requiring transfusion or surgery, developed in four patients (8%). No hemorrhagic strokes or fatalities were directly attributable to SK infusion. Coagulation parameters were determined before infusion, 4 and 24 hours after infusion, and every 24 hours thereafter. Significant alterations of coagulation parameters developed promptly, but were not very useful in predicting either clinical response or hemorrhage. Selective intra-arterial infusion of SK is a moderately effective and safe therapeutic technique in acute peripheral arterial thromboembolic disease. A comparison with prior reports suggests that selective low-dose infusion provides a moderate gain in benefit-risk ratio over systemic infusion.