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February 22, 1971

Urokinase-Heparin Treatment of Embolism

JAMA. 1971;215(8):1325. doi:10.1001/jama.1971.03180210069020

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To the Editor.—  The elaborate study of urokinase in pulmonary embolism (214:2163, 1970) compared the effects of this enzyme with that of heparin.In this protocol, a patient weighing 150 lb receives a loading dose of 11,250 units of heparin followed by a constant heparin infusion of 1,500 units every hour for 12 hours, a total of an additional 18,000 units. In a massive sublethal pulmonary embolism, at least 60,000 units have been administered on my service since 1944. The incidence of bleeding is from 4% to 6%. The intermittent dosage not only favors the saturation of the blood around the thrombus and the storage in connective tissue, but seems to be tolerated much better since the body disposes or neutralizes the excess.It is not stated how much less heparin the patients needed after the urokinase infusion. Although the bleeding occurred in the first 24 hours of the