Thus, our studies confirmed the efficacy of the rt-PA bolus, but they also showed that the standard therapeutic approach has to be improved. More effective concomitant adjunctive treatment and use of a plasminogen activator with a prolonged half-life appear, at present, to be promising approaches. The definite role of these emerging strategies will depend on their clinical efficacy and safety, with bleeding side effects being the main concern.
Thrombolytic Therapy in Venous Thromboembolism
While the effectiveness and the role of thrombolytic agents in acute myocardial infarction are firmly established, their use in patients with venous thromboembolism remains infrequent and controversial. Two large controlled studies* in patients with pulmonary embolism have shown that both streptokinase and urokinase are more effective than heparin in accelerating clot lysis and pulmonary tissue reperfusion. However, there were no differences in pulmonary reperfusion between streptokinase or urokinase and heparin groups 7 days after the treatment. Furthermore, the frequency of bleeding was significantly increased in streptokinase- and urokinase-treated patients.