Massive pulmonary embolism: treatment with full heparinization and topical low-dose streptokinase.

Three patients with massive pulmonary embolism were treated with low-dose streptokinase (delivered topically via the pulmonary artery) and simultaneous full-dose heparin. In two patients with acute emboli, rapid but incomplete lysis was observed over 15-30 hours. In one patient with recurrent embolization over three weeks, the major embolus shrank considerably. Pulmonary artery pressure and angiographic findings improved significantly in both patients with acute emboli. In the patient with old embolus, pulmonary artery pressure did not improve despite considerable improvement in angiographic findings and arterial PO2. These data suggest that early topical administration of low-dose streptokinase plus full-dose heparin may be the treatment of choice for patients with massive pulmonary embolism, particularly those with compromised cardiopulmonary status.