Urokinase or heparin in the management of patients with deep vein thrombosis?

Twenty patients with clinical signs of deep vein thrombosis of a duration not exceeding 72 hours, and with the condition confirmed phlebographically, were randomly allocated to one of two groups in a double-blind study. In group 1 the patients received urokinase in a low-dose regimen of 200 000 Ploug units during the first 24 hours, followed by infusion of heparin, 40 000 units daily during the next 5 days. Patients in group 2 received heparin only, 40 000 units daily for 6 days. The clinical course was assessed daily. When the infusion period was completed, the phlebography was repeated, and the results of the two examinations were compared with respect to extent of filling defects and the degree of non-filling of the deep veins. We found no superiority in the regimen consisting of urokinase preceding heparin infusion, compared with that of heparin infusion alone. Most of the patients improved clinically during the 6-day infusion period, but the degree of thrombosis, evaluated phlebographically, was unaltered or even deteriorated during the period in all patients except two. Overt bleeding was noted in 6 patients.