Summary
In a prospective, randomized trial 33 patients with deep vein thrombosis were treated
either with 2,200 or 1,100 IU/kg/h urokinase or with 100,000 IU/h streptokinase for
at least 6 days. While streptokinase was given continuously, urokinase was administered
intermittently (12 hr urokinase alternating with 12 hr heparin).
Urokinase treatment resulted in a dose-dependent fibrinolytic state with shortening
of the euglobulin clot lysis time, easily demonstrable amidolytic activity and moderate
decrease of plasminogen. At the end of each urokinase-free interval the fibrinolytic
activity had mostly faded, but was reproducibly elicited again by each new urokinase
administration. Streptokinase immediately evoked the customary, intense fibrinolytic
state, which progressively tapered off as plasminogen fell to 1% of its pretreatment
concentration. In all treatment groups α-2-antiplasmin dropped to approximately 40%
of its initial value during the first 12 hr with a further decrease to about 20% after
6 days, α-2-macroglo- bulin fell only moderately with either urokinase regimen, whereas
it decreased progressively to 45% under streptokinase.
While the fibrinolytic activity decreased under streptokinase over the 6-day infusion
period, it appeared to increase with each successive urokinase infusion particularly
with 1100 IU/kg/h. Thus the final euglobulin clot lysis times and the final fibrinogen
concentrations were similar in all three treatment groups on the sixth day.
Keywords
Streptokinase dosage - Urokinase dosage - Fibrinolytic activity - Plasma inhibitors
of fibrinolysis
