What is the difference between heparin and streptokinase

In-hospital mortality and clinical course of patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. Lancet Jul 14 GISSI A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among patients with acute myocardial infarction. Lancet Jul 14 Controversy continues over the relative merits of streptokinase and tissue plasminogen activator TPA in acute myocardial infarction.

Citation s : The International Study Group. By continuing to use our site, you accept the use of these cookies. In 19 published trials, this form of lytic therapy has been shown to be associated with greater venous valvular and venous patency preservation, implying better short-term and long-term outcome.

Unfortunately, closer examination of the data reveals several flaws, including overreliance on venogram data and lack of adequate long-term follow-up. Streptokinase, as well as other forms of lytic therapy, has not gained widespread acceptance in the treatment of acute deep venous thrombosis, and, until better data become available, such reluctance seems justified.

Sidorov J. Arch Intern Med. Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Six studies provided data on recurrent pulmonary embolism. A recurrence occurred in 14 6. Excessive bleeding is the trade-off for improved efficacy. The incidence of a first episode of pulmonary embolism in acute care hospitals in the United States has been found to be 0.

Thrombolytic agents provide a more rapid lysis of pulmonary emboli and reduction of pulmonary hypertension than heparin. No conclusive clinical outcome studies aimed at comparing thrombolysis and heparin treatment in patients with pulmonary embolism are available.

We performed a meta-analysis of studies comparing thrombolysis and heparin treatment in patients with pulmonary embolism with respect to the occurrence of death, recurrence of pulmonary embolism, and bleeding events. Randomized clinical trials comparing thrombolysis and heparin for treatment of pulmonary embolism were identified by computer-aided search MEDLINE , scan of meeting abstracts, and scrutiny of the reference lists of original research and review articles.

Trials were included in this meta-analysis if data concerning death and major bleeding events were available. Data extraction from the individual trials was independently performed by the authors. Discrepancy between the results obtained by the authors concerning selection and extraction of data was resolved by consensus. The primary outcome of this meta-analysis was the incidence of adverse clinical outcome events death, recurrence of pulmonary embolism, and major bleeding events. Recurrence of pulmonary embolism was considered among the adverse clinical outcome events, when reported, because it has been recently shown to be a predictor of in-hospital mortality.

An analysis of the overall bleeding events major and minor was performed. Data on patients with intracranial and fatal bleeding were extrapolated from the more general population data of patients with major bleeding.

Bleeding events were also considered separately as associated or not with invasive procedures. No assumption regarding the comparability of patients between the different studies was used because all the statistical calculations are based on the comparison within each single trial. The analysis was performed cumulatively for the overall adverse outcome events, separately for each adverse outcome event death, major bleeding event, and recurrence of pulmonary embolism , and for death and recurrence together.

To avoid the overestimation of adverse events, patients with multiple events were counted only once. The number needed to treat and the number needed to harm were also indicated when appropriate. The results of each trial were analyzed on an intention-to-treat basis. Eleven clinical trials comparing thrombolysis and heparin use for the treatment of pulmonary embolism were identified. Two trials were excluded from this analysis because they were nonrandomized. Patients included in double-blind studies accounted for Overall, patients were included in the analysis: With a single exception, 9 the observation period was limited to the hospital stay, and no data were provided on the long-term clinical outcome Table 1.

Adverse clinical events, death, recurrence of pulmonary embolism, and major bleeding events were first analyzed cumulatively. Across all studies, adverse clinical events occurred in 56 patients Thirty-one patients undergoing thrombolysis Overall, 5 patients, all of them in the thrombolysis group 2.

Fatal bleeding events were as follows: 3 gastrointestinal, 1 intracranial, and 1 cardiac tamponade. One additional patient undergoing thrombolysis died and had intracranial bleeding, but death was attributed to the recurrence of pulmonary embolism.

In 5 of the 9 studies, invasive procedures were performed, essentially catheter insertion for pulmonary angiography. The incidence of major bleeding in patients receiving thrombolytic treatment in studies with and without invasive procedures was The incidence of major bleeding in patients receiving heparin in studies with and without invasive procedures was The rate of overall bleeding events was A statistically significant increase of overall bleeding in patients undergoing thrombolysis was observed in 1 double-blind trial.

Six studies, 4 , 8 , 10 - 12 , 15 including patients, reported the incidence of recurrence of pulmonary embolism Table 2. This event occurred in 14 6. When death and recurrence were considered together, an RR of 0.