Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin
The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase, 10,000-20,000 units/hour, was administered directly i...
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| Veröffentlicht in: | Chest 1988-02, Vol.93 (2), p.234-240 |
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| creator | K V Leeper, Jr J Popovich, Jr B A Lesser D Adams J W Froelich M W Burke P C Shetty J H Thrall P D Stein |
| description | The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin
was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase,
10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was
administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 +/-
2 to 2 +/- 1 after 12-24 hours (p less than .01). No change was shown in the contralateral lung. The angiographic index of
severity score in the infused lung decreased from 16 +/- 1 to 9 +/- 4 (p less than .01). The partial pressure of oxygen in
arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes
occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous
heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full
dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk. |
| doi_str_mv | 10.1378/chest.93.2.234 |
| format | Article |
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was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase,
10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was
administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 +/-
2 to 2 +/- 1 after 12-24 hours (p less than .01). No change was shown in the contralateral lung. The angiographic index of
severity score in the infused lung decreased from 16 +/- 1 to 9 +/- 4 (p less than .01). The partial pressure of oxygen in
arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes
occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous
heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full
dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.93.2.234</identifier><identifier>PMID: 3338289</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: American College of Chest Physicians</publisher><subject>Aged ; Biological and medical sciences ; Blood. Blood coagulation. Reticuloendothelial system ; Drug Therapy, Combination ; Female ; Hemorrhage - chemically induced ; Heparin - administration & dosage ; Heparin - adverse effects ; Humans ; Infusions, Intravenous ; Male ; Medical sciences ; Middle Aged ; Oxygen - physiology ; Pharmacology. Drug treatments ; Pulmonary Artery ; Pulmonary Embolism - drug therapy ; Pulmonary Embolism - physiopathology ; Risk Factors ; Streptokinase - administration & dosage ; Streptokinase - adverse effects</subject><ispartof>Chest, 1988-02, Vol.93 (2), p.234-240</ispartof><rights>1988 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7720096$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3338289$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>K V Leeper, Jr</creatorcontrib><creatorcontrib>J Popovich, Jr</creatorcontrib><creatorcontrib>B A Lesser</creatorcontrib><creatorcontrib>D Adams</creatorcontrib><creatorcontrib>J W Froelich</creatorcontrib><creatorcontrib>M W Burke</creatorcontrib><creatorcontrib>P C Shetty</creatorcontrib><creatorcontrib>J H Thrall</creatorcontrib><creatorcontrib>P D Stein</creatorcontrib><title>Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin</title><title>Chest</title><addtitle>Chest</addtitle><description>The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin
was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase,
10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was
administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 +/-
2 to 2 +/- 1 after 12-24 hours (p less than .01). No change was shown in the contralateral lung. The angiographic index of
severity score in the infused lung decreased from 16 +/- 1 to 9 +/- 4 (p less than .01). The partial pressure of oxygen in
arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes
occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous
heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full
dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood. Blood coagulation. Reticuloendothelial system</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Hemorrhage - chemically induced</subject><subject>Heparin - administration & dosage</subject><subject>Heparin - adverse effects</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Oxygen - physiology</subject><subject>Pharmacology. Drug treatments</subject><subject>Pulmonary Artery</subject><subject>Pulmonary Embolism - drug therapy</subject><subject>Pulmonary Embolism - physiopathology</subject><subject>Risk Factors</subject><subject>Streptokinase - administration & dosage</subject><subject>Streptokinase - adverse effects</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1988</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkUtv1TAQhS0EKreFLTskLxC7BD_yXKKKl1SJzWUdTewJcfEj2A5X_Sn8W1x61a5Go_OdI80ZQt5wVnPZDx_UiinXo6xFLWTzjBz4KHkl20Y-JwfGuKhkN4qX5DKlW1Z2PnYX5EJKOYhhPJC_x4iQHfpMw0IdpGT-IAW1Z6Tbbl3wEO8oujlYk1xNjyvSPeE9bMOJ6pAw3S_G5whPBogZowFLU4645fDLeCguFdxsPGp6Mnmly27tU0K6SxmdUXTFDaLxr8iLBWzC1-d5RX58_nS8_lrdfP_y7frjTbWKvsmVGKEVnVoU6JaLBQdAJTR0GmdcRCM4b-cZBeqBNazlWqph4AOwRSObRdvKK_L-IXeL4fdeypycSQqtBY9hT1M_sOKQTQHfnsF9dqinLRpXbp3OXRb93VmHpMAuEbwy6RHre8HY2BWsfsBW83M9mYhTcmBtCZXT_2fehj16sKOcxFReKv8Bk0KY_w</recordid><startdate>19880201</startdate><enddate>19880201</enddate><creator>K V Leeper, Jr</creator><creator>J Popovich, Jr</creator><creator>B A Lesser</creator><creator>D Adams</creator><creator>J W Froelich</creator><creator>M W Burke</creator><creator>P C Shetty</creator><creator>J H Thrall</creator><creator>P D Stein</creator><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>19880201</creationdate><title>Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin</title><author>K V Leeper, Jr ; J Popovich, Jr ; B A Lesser ; D Adams ; J W Froelich ; M W Burke ; P C Shetty ; J H Thrall ; P D Stein</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-h274t-29a526cfcad512fe8aec2da6debef242115bbe2ed804051d3c8818a0fde0b2553</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1988</creationdate><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood. Blood coagulation. Reticuloendothelial system</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Hemorrhage - chemically induced</topic><topic>Heparin - administration & dosage</topic><topic>Heparin - adverse effects</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Oxygen - physiology</topic><topic>Pharmacology. Drug treatments</topic><topic>Pulmonary Artery</topic><topic>Pulmonary Embolism - drug therapy</topic><topic>Pulmonary Embolism - physiopathology</topic><topic>Risk Factors</topic><topic>Streptokinase - administration & dosage</topic><topic>Streptokinase - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>K V Leeper, Jr</creatorcontrib><creatorcontrib>J Popovich, Jr</creatorcontrib><creatorcontrib>B A Lesser</creatorcontrib><creatorcontrib>D Adams</creatorcontrib><creatorcontrib>J W Froelich</creatorcontrib><creatorcontrib>M W Burke</creatorcontrib><creatorcontrib>P C Shetty</creatorcontrib><creatorcontrib>J H Thrall</creatorcontrib><creatorcontrib>P D Stein</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>K V Leeper, Jr</au><au>J Popovich, Jr</au><au>B A Lesser</au><au>D Adams</au><au>J W Froelich</au><au>M W Burke</au><au>P C Shetty</au><au>J H Thrall</au><au>P D Stein</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1988-02-01</date><risdate>1988</risdate><volume>93</volume><issue>2</issue><spage>234</spage><epage>240</epage><pages>234-240</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin
was investigated. Seven patients with angiographically proven massive acute pulmonary embolism were treated. Streptokinase,
10,000-20,000 units/hour, was administered directly into the left or right pulmonary artery for 9 to 24 hours. Heparin was
administered concurrently. The number of unperfused segments of the infused lung shown on the lung scan decreased from 5 +/-
2 to 2 +/- 1 after 12-24 hours (p less than .01). No change was shown in the contralateral lung. The angiographic index of
severity score in the infused lung decreased from 16 +/- 1 to 9 +/- 4 (p less than .01). The partial pressure of oxygen in
arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major bleeding episodes
occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous
heparin, may provide a therapeutic option in patients with life-threatening massive acute pulmonary embolism in whom full
dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.</abstract><cop>Northbrook, IL</cop><pub>American College of Chest Physicians</pub><pmid>3338289</pmid><doi>10.1378/chest.93.2.234</doi><tpages>7</tpages></addata></record> |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Aged Biological and medical sciences Blood. Blood coagulation. Reticuloendothelial system Drug Therapy, Combination Female Hemorrhage - chemically induced Heparin - administration & dosage Heparin - adverse effects Humans Infusions, Intravenous Male Medical sciences Middle Aged Oxygen - physiology Pharmacology. Drug treatments Pulmonary Artery Pulmonary Embolism - drug therapy Pulmonary Embolism - physiopathology Risk Factors Streptokinase - administration & dosage Streptokinase - adverse effects |
| title | Treatment of massive acute pulmonary embolism. The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin |
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