Deep vein thrombosis: streptokinase lyses clots better but causes more major bleeds than heparin.

Clinical bottom line (level 1a)

  1. Patients with DVT who were given streptokinase have better clot lysis than those given heparin (NNT = 4 at 7 days) , but are more likely to have a major bleed (NNH = 17 at 7 days) .
  2. The relationship of thrombus resolution to clinical endpoit is unclear
Goldhaber et al: American Jornal of Medicine 1984; 76: 393-397
Expires May 2003

The study

Systematic review of randomised controlled trials of
  • Patients: venographically proven deep vein thrombosis
  • Intervention: streptokinase (typically given as a loading dose250 000 to 500,000 U and an infusion of 100,000 U per hour over 1-5 days) compared with heparin (typically given as a loading dose of 7,500 to 10,000 U and an infusion of 1,000 to 1,500 U per hour for 2.5-10 days)
  • Outcome: thrombolysis and major bleeds
Articles found in ? using ?, ? (search terms: none given)

Selection criteria: as above
Appraisal criteria: using set criteria (not stated)
Articles excluded if: none given

six trials were included
There was no heterogeneity found between the trials.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
thrombolysis 7 days 16/
(17.6%)		 3.7
(2.5 to 5.7) 		4
(3 to 6)
major bleed 7 days 2/
(3.39%)		 2.9
(1.1 to 8.1) 		17
(5 to 306)

Comments

  1. There were no studies on the long term effects on recurrent venous thromboembolism or post-phlebitic syndrome.
  2. Methodological criteria were not given, how good was the search?

Citation

  1. Goldhaber SZ, Buring E, Lipnick J, et al: Pooled analysis of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. American Jornal of Medicine 1984; 76: 393-397
Contributor: Chris Ball and Clare Wotton, May 2000
Reviewer: Alex Gallus

Clinical Question.
Patient DVT
Intervention or Exposure streptokinase
Comparison heparin
Outcome thrombolysis