Thrombolytic treatment of acute pulmonary embolism. Streptokinase again on scene?

No randomized mortality study has been done comparing the results of the thrombolytic treatment in life threatening acute pulmonary embolism by streptokinase and tissue plasminogen activator. Consequently, contemporary guidelines mention both these drugs as practically comparable for thrombolytic therapy of acute pulmonary embolism. But a detailed analysis of characteristics of streptokinase shows that its administration has a number of disadvantages. It includes possible occurrence of allergic reaction to anaphylactic shock, attenuation to full diminishing of lytic response with regard to occurrence of antibodies of streptokinase in remarkable part of population. It includes also development of serious hypotension in some of the treated, and also longtime presence of neutralizing antibodies after its application that resulting in impossibility of repeated administration. Very significant is also less beneficial affect on pulmonary hemodynamics and functions of right ventricle within the first hours after use and more than 24 hours lasting severe decline of serum fibrinogen threatening the patient in case of intervention or operation. Present procoagulant impact can impair thrombolytic influence and support the relapse of pulmonary embolism. Their only advantage is relatively low price which cannot restore balance between these disadvantages and resulting risks of its administration. Therefore we must clearly prefer the tissue plasminogen activator as the drug of first choice in this indication.

Keywords: acute pulmonary embolism, thrombolytic therapy, streptokinase, tissue plasminogen activator