Massive pulmonary embolism: treatment with full heparinization and topical low-dose streptokinase.

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Abstract
Three patients with massive pulmonary embolism were treated with low-dose streptokinase (delivered topically via the pulmonary artery) and simultaneous full-dose heparin. In 2 patients with acute emboli, rapid but incomplete lysis was observed over 15-30 h. In 1 patient with recurrent embolization over 3 wk, the major embolus shrank considerably. Pulmonary artery pressure and angiographic findings improved significantly in both patients with acute emboli. In the patient with old embolus, pulmonary artery pressure did not improve despite considerable improvement in angiographic findings and arterial PO2 [O2 partial pressure]. Apparently, early topical administration of low-dose streptokinase plus full-dose heparin may be the treatment of choice of patients with massive pulmonary embolism, particularly those with compromised cardiopulmonary status.