Choice of agent for peripheral thrombolysis

Evidence has been accumulating that tissue plasminogen activator (tPA) is a more rapid and effective agent than streptokinase for peripheral thrombolysis. Twenty-three patients with acute limb-threatening ischaemia treated with tPA (0.5 mg h-1) over 15 months were compared with 20 consecutive patients previously receiving streptokinase (5000-10,000 units h-1). There were no major differences between the rates of complete and partial lysis (61 per cent for tPA versus 65 per cent for streptokinase) or limb salvage (65 versus 55 per cent respectively). Complication rates were also similar. It was not possible to show that tPA, an agent ten times more expensive than streptokinase, was superior for peripheral thrombolysis.