Low-dose streptokinase for selective thrombolysis: systemic effects and complications.

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Abstract
The systemic effects and complications associated with the infusion of low-dose (5,000 U/h) i.v. streptokinase were reviewed in 159 patients. Of the patients, 82% had a 50% decrease in plasma fibrinogen levels during the first 4 h of treatment, and 100% of the patients showed the same decline following 12 h of treatment. The thrombin time was prolonged to at least 1 1/2 times the control thrombin time in 42% of the patients at 4 h of treatment and in 92% at 24 h of treatment. The rate or degree of change in fibrinogen levels or prolongation of the thrombin time did not correlate with the incidence of complications. Patients (17) (10.7%) suffered major complications. Of the 17, 13 had hemorrhagic complications, 3 had thrombotic or embolic complications and 1 had a false aneurysm. In this series, systemic effects occurred in all patients. Despite precautionary measures, hemorrhagic complications may occur. Steps should be taken to minimize complications, including careful observation of the patient and monitoring of plasma fibrinogen levels until adequate regeneration is complete.

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