[Value of thrombolytic therapy in deep venous thrombosis]

Thrombolytic therapy in a large number of patients may prevent post-thrombotic symptoms occurring as late consequences of deep vein thrombosis. In clinical studies, streptokinase either in conventional low dose, longterm, intravenous or in repeated intravenous short term ultra high dose regimens, urokinase and recombinant tissue-type plasminogen activators: all these plasminogen activators have been confirmed to successfully restore the patency of veins. As deep vein thrombosis generally extends over longer distances and are mostly older before being diagnosed, a lysing period of a couple of days must be taken into account. On the other hand, deep vein thromboses aged more than 2 weeks generally are no longer amenable to thrombolytic treatment. Due to their lack of short-term and long-term hazards, thromboses of the arms and the lower legs are not regarded an ideal indication for thrombolysis. Up to now, none of the currently available plasminogen activators has demonstrated superiority over the others, neither in respect of efficacy nor safety. With streptokinase intermittent intravenous ultra-high doses success rates of up to 80% (complete plus partial recanalization) can be achieved within a three-day treatment period. For its accompanying increased hazard of fatal pulmonary embolism, however, it is considered to be contraindicated in patients with pelvine thrombosis. Furthermore, contraindications to streptokinase such as streptococcal infections and prior lysis with streptokinase should always be kept in mind. In these cases streptokinase may be substituted by rt-PA, which, however, in the indication of deep vein thrombosis, is still not well documented today.(ABSTRACT TRUNCATED AT 250 WORDS)