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July 1986

Intra-arterial Fibrinolytic Therapy: Efficacy of Streptokinase vs Urokinase

Author Affiliations

From the Departments of Surgery (Drs M. Belkin, Bucknam, and Lowe) and Radiology (Drs B. Belkin and Straub), Hartford (Conn) Hospital.

Arch Surg. 1986;121(7):769-773. doi:10.1001/archsurg.1986.01400070035007

• This study is a retrospective comparison of the results in 25 low-dose, intra-arterial streptokinase and 12 low-dose intra-arterial urokinase infusions for thromboembolic disease. Intra-arterial streptokinase was successful in 50% of infusions and was marked by significant abnormalities in the coagulation criteria. There was a high incidence of major and minor bleeding (48% overall), which could be attributed to systemic effects of the drug. Urokinase was successful in 100% of infusions, and showed no significant effects on systemic coagulation criteria. There were also fewer complications during urokinase infusion. The average pharmacy cost for a course of intra-arterial streptokinase was $165, while urokinase cost $1142. Despite the significant difference in expense, the increased efficacy and safety of urokinase make it the preferred agent for intra-arterial infusion. Theoretical reasons for the increased effectiveness of urokinase are discussed.

(Arch Surg 1986;121:769-773)

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