QUANTITATIVE VENOGRAPHIC ASSESSMENT OF DEEP-VEIN THROMBOSIS IN EVALUATION OF STREPTOKINASE AND HEPARIN THERAPY

  • 1 January 1977
    • journal article
    • research article
    • Vol. 89  (5) , 1018-1029
Abstract
A technique of quantitative venography was developed in which values are assigned to the deep veins of the calf, knee, thigh and pelvis, based upon the calculated volume and degree of occlusion of these venous segments. A maximum score of 40 units reflects complete thrombosis of all segments. This technique was applied to a randomized, single-blind study of streptokinase vs. heparin treatment. Each group of 12 patients had similar mean initial venographic scores; follow-up venograms were performed 5 days after the start of therapy. Streptokinase patients with high initial scores (> 20) showed a mean improvement of 12.1 units, while those with low initial scores (< 20) were essentially unchanged. Heparin patients with high scores had a minimal mean improvement of 1.1 units, but those with low scores had a significant mean extension of thrombosis of 8.6 units. Patients with symptoms for < 7 days showed greater mean improvement (12.7 units) with streptokinase than those with a longer duration of symptoms (2.0 units); heparin patients in these subgroups showed a mean worsening of 7.5 units and no change, respectively. Extrinsic venous obstruction by tumor did not prevent an excellent response to streptokinase. No single test of coagulation or fibrinolysis was a reliable indicator of the degree of venographic response to lytic therapy. Pyrexia and hemorrhagic complications occurred in over 1/2 of the streptokinase patients; 1 had an anaphylactic reaction, and 1 died of intracerebral hemorrhage during therapy. Lytic therapy may be best restricted to the patient with acute extensive thrombosis. Continuous infusions of heparin according to current guidelines may be inadequate to prevent thrombus growth in some patients.