Russo R, Prandoni P, Pengo V, Boschello M, Schivazappa L
G Ital Cardiol. 1985 Oct;15(10):957-9.
Eight patients with massive pulmonary thromboembolism documented by angiography were treated with Urokinase (UK) 4.400 IU/Kg/hr for 12 hours. UK i.v. infusion was started immediately after angiographic evaluation (Miller index) and was followed by anticoagulant therapy with heparin and sodium warfarin. All patients survived even though 4 pts. were in shock before treatment. Significant reduction of pulmonary obstruction (reduction of Miller index) was obtained in 7 patients with 48 hours from withdrawal of the drug. Mild superficial bleedings which did not influence the clinical course were the only complication recorded. Neither bleedings nor angiographic improvement showed a correlation with thrombin time prolongation. Indications for thrombolytic therapy of pulmonary embolism and particularly prevention of the major haemorrhagic complications are briefly discussed. It is concluded that the high doses of UK suggested by Food and Drug Administration may be used safely in patients affected by massive pulmonary thromboembolism with or without shock, if patients are adequately selected and prevention of major haemorrhagic complications is continued throughout treatment.
8例经血管造影证实为大面积肺血栓栓塞症的患者接受了12小时、4400国际单位/千克/小时的尿激酶治疗。血管造影评估（米勒指数）后立即开始静脉输注尿激酶，随后采用肝素和华法林钠进行抗凝治疗。所有患者均存活，尽管4例患者在治疗前处于休克状态。停药后48小时内，7例患者的肺阻塞情况（米勒指数降低）有显著改善。记录到的唯一并发症是未影响临床进程的轻度浅表出血。出血情况和血管造影改善均与凝血酶时间延长无关。简要讨论了肺栓塞溶栓治疗的指征，尤其是主要出血并发症的预防。得出的结论是，如果对患者进行充分筛选并在整个治疗过程中持续预防主要出血并发症，美国食品药品监督管理局建议的高剂量尿激酶可安全用于患有大面积肺血栓栓塞症且伴有或不伴有休克的患者。
