Therapy

Why?

• Patients given streptokinase or tPA have better clot lysis ^a and are less likely to develop post-thrombotic leg ^a but are more likely to have an adverse event (death, major bleed) ^a and a pulmonary embolism. ^a
• The route of administration (systemic or local) has no clear effect on the incidence of bleeding. ^d

Streptokinase reduces post-thrombotic leg but increases pulmonary emboli

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
DVT a	systemic streptokinase	heparin	pulmonary embolism  at 7 days	0.0%	-9.0% (-15% to -3.4%)	-11 (-29 to -7)
			post-thrombotic syndrome  at 12 months	90%	14% (2.2% to 26%)	7 (4 to 45)

Streptokinase lyses clots but increases the risk of major bleeding

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
DVT a	streptokinase	heparin	clot lysis at 7 days	18%	3.7 (2.5 to 5.7)	4 (3 to 6)
			major bleed at 7 days	23%	2.9 (1.1 to 8.1)	17 (5 to 310)