PLASMINOGEN AND MODERATE DOSES OF UROKINASE IN THE TREATMENT OF ACUTE PULMONARY-EMBOLISM

Urokinase at a dose of 2,700,000 CTA units per 24 hours, combined with heparin, has proved effective in the treatment of a first series of 80 patients with severe pulmonary embolism, treated on the average at the thirty-second hour. The mortality rate was 15% and the average early revascularisation was 49%. Treatment failures or inadequate revascularisation would appear to be linked to old thrombi which are poor in plasminogen. With the aim of rendering the thrombus more sensitive to lysis, a second series of 30 patients with severe pulmonary embolism received, on average at the fourth day, an infusion of 150 micro-Katal units of placental plasminogen, followed by the same dose of urokinase and heparin used in the first series. Mortality was low (3.3%) and the average amount of early revacularization was 51%. Levels of blood plasminogen showed a greater consumption in the second series (82.6%) than in the first (73.2%) (P < 0.02), reflecting better fibrinolytic activity. Taking into consideration the good results of a combination of urokinase and heparin in the treatment of early pulmonary embolism, it is wise to reserve the prior administration of placental plasminogen to relatively old (> 4 days) pulmonary emboli. © 1979, Sage Publications. All rights reserved.