Treatment of massive XXXX . The use of low doses of intrapulmonary arterial streptokinase combined with full doses of systemic heparin.

@entity1 @entity26 @entity548 @entity1151
The efficacy of low-dose, locally administered streptokinase (SK) combined with full therapeutic systemic doses of heparin was investigated. Seven @entity1 with angiographically proven massive @entity1151 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 @entity26 in arterial blood improved within four hours. In spite of the low doses of streptokinase, however, two major @entity548 episodes occurred that required blood transfusion. In conclusion, low dose intrapulmonary streptokinase, combined with intravenous heparin, may provide a therapeutic option in @entity1 with life-threatening massive @entity1151 in whom full dose lytic therapy may be hazardous, although even low dose lytic therapy was associated with risk.
