Thrombolysis in Central Splanchnic Thrombosis

We present 4 patients treated with streptokinase for different forms of abdominal venous thrombosis. Two patients suffered from central splanchnic venous thrombosis (superior mesenteric vein and bilateral iliac veins in Patient A, portal and superior mesenteric veins in Patient B). Both patients' presenting complaint was abdominal pain. In both, a temporary infection-associated circulating lupus anticoagulant presumably caused this condition. Two other patients presented with isolated portal vein thrombosis without lupus anticoagulant. Thrombolysis with high dose streptokinase (9 MU over 6 hours) successfully reopened the veins involved in all 4 patients. A literature survey showed that thrombolysis is a therapeutic option for mesenteric vein thrombosis, but there was no consensus on which thrombolytic drug should be given or on method of administration.