Meta-analysis of streptokinase and heparin in deep vein thrombosis.

Abstract

The efficacy and safety of streptokinase and heparin in deep vein thrombosis (DVT) were compared in a meta-analysis. Randomized trials in which streptokinase (followed by heparin) and heparin alone were compared in treating phlebographically documented acute DVT were identified from MEDLINE and other sources for a meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) based on the logit method were computed for each study. A fixed-effect model was used to combine the study results, enabling differences between streptokinase recipients and recipients of heparin alone to be expressed as summary ORs with 95% CIs. Significantly more streptokinase recipients achieved thrombolysis than recipients of heparin alone (summary OR, 6.24; 95% CI, 3.62 to 10.78). One study was identified as an outlier and excluded from the analysis. The meta-analysis then showed that streptokinase recipients were significantly less likely to have postthrombotic changes (summary OR, 0.40; 95% CI, 0.18 to 0.88) and postphlebitic changes (summary OR, 0.32; 95% CI, 0.12 to 0.86) in phlebographic evaluation. The frequency of major bleeding was significantly higher among streptokinase recipients than recipients of heparin alone (summary OR, 3.78; 95% CI, 1.26 to 11.32). A meta-analysis showed that, compared with heparin alone, streptokinase therapy for DVT was associated with significantly more frequent thrombolysis and major bleeding; after exclusion of one outlying study, analysis showed that streptokinase therapy was associated less frequently than heparin alone with postthrombotic changes (assessed by phlebographic evaluation) and postphlebitic syndrome.

• Authors: C M Ng, J O Rivera
• Journal: American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (Am J Health Syst Pharm) Vol. 55 Issue 19 Pg. 1995-2001 (Oct 01 1998) ISSN: 1079-2082 [Print] England
• PMID: 9784786 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)

Chemical References

• Fibrinolytic Agents
• Heparin
• Streptokinase

Topics

• Fibrinolytic Agents (adverse effects, therapeutic use)
• Hemorrhage (chemically induced, pathology)
• Heparin (therapeutic use)
• Humans
• Randomized Controlled Trials as Topic
• Streptokinase (adverse effects, therapeutic use)
• Treatment Outcome
• Venous Thrombosis (blood, drug therapy, pathology)