Effect of Thrombolytic Therapy on Pulmonary-Capillary Blood Volume in Patients with Pulmonary Embolism

• Published in: The New England journal of medicine Vol. 303; no. 15; pp. 842 - 845
• Main Authors: Sharma, G. V. R. K, Burleson, Virginia A, Sasahara, Arthur A, Roggeveen, Barbara, Mondello, Nazarene, Guilford, Helen
• Format: Journal Article
• Language: English
• Published: United States Massachusetts Medical Society 09.10.1980
• Subjects: Airway management; Anticoagulants; Blood; Blood Volume - drug effects; Capillaries - physiopathology; Carbon monoxide; Catheters; Embolism; Embolisms; Fibrinolytic Agents - pharmacology; Fibrinolytic Agents - therapeutic use; Health risk assessment; Heparin; Heparin - pharmacology; Humans; Lung diseases; Medical imaging; Patients; Perfusion; Pulmonary arteries; Pulmonary Circulation - drug effects; Pulmonary Diffusing Capacity; Pulmonary Embolism - drug therapy; Pulmonary Embolism - physiopathology; Pulmonary embolisms; Streptokinase; Streptokinase - pharmacology; Thromboembolism; Thrombolysis; Thrombosis; U-Plasminogen activator; Urokinase-Type Plasminogen Activator - pharmacology
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM198010093031502

To compare the effects of heparin thrombolytic agents in pulmonary thromboembolic disease, we randomly assigned 40 patients with pulmonary emboli but without other clinical cardiopulmonary disease either to heparin followed by oral anticoagulants (21 patients) or to urokinase or streptokinase followed by heparin and then by oral anticoagulants (19 patients). The effects on pulmonary-capillary blood volume and diffusing capacity were compared at two weeks and at one year. The pulmonary-capillary blood volume (in milliliters per square meter of body-surface area) was abnormally low (30±2.4) [±S.E.]; normal, 47±1.5) in the heparin-treated group at two weeks and remained unchanged at one year. In contrast, it was normal (45±2.5) in the group receiving thrombolytic agents, both at two weeks and at one year (P<0.001). The pulmonary diffusing capacity was reduced to 69 per cent of the predicted value in the heparin group at two weeks and 72 per cent at one year, whereas it was 85 per cent of the predicted value in the thrombolytic group at two weeks and 93 per cent at one year (P<0.001). These results indicate that thrombolytic agents allow more complete resolution of thromboemboli than do heparin and anticoagulants and that they improve capillary perfusion and diffusion. (N Engl J Med. 1980; 303:842–5.) TREATMENT of venous thromboembolic disease is primarily preventive, consisting of heparin and oral anticoagulant therapy. The recent introduction of the thrombolytic agents streptokinase and urokinase represents an important new development in management of this problem. The early studies 1 and the later cooperative trials sponsored by the National Institutes of Health 2 , 3 established the beneficial effects of streptokinase and urokinase on lung perfusion and hemodynamics and on angiographic and clinical status in patients with acute pulmonary embolism. Although the effects of these agents on massive and submassive embolism are well documented, the effects on small, peripheral pulmonary clots, which are beyond the . . .