Efficacy of low-dose streptokinase in acute arterial occlusion and graft thrombosis.

In a review of 35 patients undergoing local thrombolysis using selective infusion of low-dose streptokinase, the overall success rate was 43%. Streptokinase appears to be most effective in occlusion of native arteries, in high-flow segments, and in autogenous saphenous vein grafts. Local streptokinase was least effective in occluded prosthetic grafts in the femoropopliteal segment (19% success). Distal embolization and progression of thrombosis of the distal arterial tree may occur while the patient is undergoing local thrombolysis and may result in limb loss. Hence, local thrombolysis is not recommended when surgical treatment is an alternative. Despite the low dose, systemic fibrinolytic effects and hemorrhagic complications were common occurrences; hence, routine hematologic monitoring is mandatory in patients undergoing lytic therapy with local infusion of streptokinase.