An evaluation of fibrinolytic therapy of pulmonary thromboembolism using non-invasive examinations and the relationship of urokinase dosage to clinical outcome and coagulation-fibrinolytic changes.
We administered urokinase (UK) 24 x 10(4) unit (U.) + dextran sulfate (DS) 1,500 or 3,000 mg (UK24), UK 48 x 10(4) U. + DS 3,000 mg (UK48) and UK 60 x 10(4) U. (UK60) over 6 hrs daily for 5 consecutive days to 26 patients with pulmonary thromboembolism (PTE). The fibrinolytic effect of UK was evaluated by a combination of clinical and laboratory findings (score), isotopic perfusion defect and A-a DO2. Prominent recovery was observed in 60% cases of the UK48 and UK60 groups but none in the UK24 group. Fibrin degradation products (FDP) D and D-D increased significantly when alpha 2 plasmin inhibitor (alpha 2PI) decreased to less than 3 mg/dl. These results suggest that fibrinolytic therapy of PTE can be evaluated objectively using noninvasive examinations and UK treatment is successful when 48 or 60 x 10(4) U. of UK is administered over 6 hrs and a 50% decrease of alpha 2PI is obtained.
Oguma
Y
Y
First Department of Medicine, Hokkaido University School of Medicine, Sapporo, Japan.
Hasegawa
H
H
Kawakami
Y
Y
D000328:Adult; D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000032:analysis / Q000097:blood; D011650:Pulmonary Alveoli / Q000032:analysis; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011877:Radionuclide Imaging; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator; D010100:Oxygen