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fibrinolysis in venous thrombosis for all type of patients, clinical trials results

arvin versus no fibrinolysis
Kakkar (arvin), 1969
streptokinase 500,000 U IV over 30 minutes, 900,000 U every 6 hours for 5 days
versus
heparin 10,000 U over 5 minutes, then 10,000 to 15,000 U every 6 hours for 5 dayslicatio
patients with venographically confirmed DVT of leg of duration < 4 dayssingle blind
UK
streptokinase versus no fibrinolysis
Arneson, 1978
streptokinase 250,000 U loading IV, then 100,000 IU/hour IV 72-96 hours
versus
heparin 15,000 IU IV bolus, 30,000 IU infusion IV 72-90 hours¢ßl
inpatients with venographically confirmed DVT extending proximally beyond the calf <5 days duration?single blind
Norway
Common, 1976
hydrocortisone 100 mg IV then streptokinase IV 250,000 U over 30 minutes, then 100,000 U/hour titrated for 72 hours. Followed by IV heparin titrated over 7 days
versus
IV heparin 150 U/kg loading dose then titrated for 10 days
patients with venographically confirmed DVT duration < 14 dayssingle blind
US
Elsharawy, 2002
catheter-directed thrombolysis with streptokinase using popliteal approach.
versus
heparin IV bolus 5000 U, then adjusted continuous infusion. Warfarin begun the same evening
iliofemoral venous thrombosis confirmed by duplex or venography duration < 10 daysicatiosingle blind
Egypt
Schulman, 1986
streptokinase 50,000 IU IV over 15 minutes then 100,000 IU over 12 hours for up to 7 days, titrated. Given with 5000 IU heparin IV over 12 hours. Warfarin begun after streptokinase ended
versus
heparin 5000 IUIVbolus then 30,000 IUper day, titrated for 7 days.Warfarin begun simultaneously
patients with venographically confirmed calf vein thrombosis of duration < 7 days.single blind
Sweden
Tsapogas, 1973
titrated dose of streptokinase IV into ankle veinmage/pj
versus
heparin IV into affected limbitm
patients with DVT confirmed by venogram of duration < 5 days.open
US
Kakkar (streptokinase), 1969
streptokinase 500,000 U IV over 30 minutes, 900,000 U every 6 hours for 5 days
versus
heparin 10,000 U over 5 minutes, then 10,000 to 15,000 U every 6 hours for 5 dayslicatio
patients with venographically confirmed DVT of leg of duration < 4 dayssingle blind
UK
Schweizer (systemic SK), 2000
Systemic streptokinase 3,000,000 U/day over 6 hours in conjunction with heparin for up to 7 days. Premedication: hydrocortisone 100 mg, ranitidine 50 mg, clemastine 2 mg
versus
heparin IV, adjusted
patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 dayssingle blind
Germany
tPA versus no fibrinolysis
Goldhaber (tPA alone), 1990
tPA alone 0.05 mg/kg/hour IV over 24 hours, then heparin100U/kg bolus, then 1000 U/hour, adjusted
versus
heparin alone 100 U/kg bolus, then 1000 U/hour
venographically documented DVT, in popliteal ormore proximal veins < 14 days durationsingle blind
US
Schweizer (local tPA), 2000
local tPA 20 mg/day, over 4 hours via pedal vein for 4-7 days. IV heparin given simultaneously at 1000 IU/hour, adjusted
versus
heparin IV, adjusted
patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 dayssingle blind
Germany
Turpie, 1990
tPA + IV heparin
versus
5000 U bolus then 30,000 U/24 hours, adjusted for 7-10 days (+placebo)
patients with venographically confirmed proximal DVT of lower limb of duration < 7 daysdouble blind
Canada
Verhaeghe (high dose), 1989
IV tPA 100 mg on day 1, 50 mg tPA on day 2. 10% of dose given as bolus; heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours
versus
heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours (+placebo)
hospitalised patients with DVT of popliteal or more proximal veins of the lower leg, confirmed by venography of duration < 10 days.double blind
France, Belgium, Switzerland
Goldhaber (tPA+heparin), 1990
tPA 0.05 mg/kg/hour IV over 24 hours and heparin 100U/kg bolus, then 1000 U/hour, adjusted
versus
heparin alone 100 U/kg bolus, then 1000 U/hour.
patients with venographically documented DVT, in popliteal ormore proximal veins < 14 days durationsingle blind
US
Verhaeghe (low dose), 1989
IV tPA 50 mg on day 1, repeated on day 2. 10% of dose given as bolus; heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours
versus
heparin 5000 U IV bolus then continuous infusion of 1000 U per hour for up to 72 hours (+placebo)
hospitalised patients with DVT of popliteal or more proximal veins of the lower leg, confirmed by venography of duration < 10 days.double blind
France, Belgium, Switzerland
tPA+heparin versus no fibrinolysis
Schweizer tPA, 1998
tPA 20 mg IV into pedal vein over 4 hours each day for 7 days. Heparin IV given concomitantly, with adjustment
versus
heparin IV, adjusted for 7 days
patients with venographically confirmed DVT of leg duration < 7 days.single blind
Germany
urokinase versus no fibrinolysis
Kiil, 1981
urokinase 200,000 U IV over 24 hours. After 18 hours, heparin loading dose of 15,000 units then 40,000 U/day for 5 days (+placebo)
versus
heparin 40,000 U/day IV for 6 days (+placebo)
patients with venographically confirmed DVT duration < 72 hoursDouble blind
Denmark
Schweizer (urokinase), 1998
Urokinase 100,000 IU/hr IV into pedal vein continuously for 7 days. Heparin IV for 7 days. Plasminogen monitored. Warfarin from day 7 to 12 monthsd=132
versus
heparin IV, adjusted for 7 days
patients with venographically confirmed DVT of leg duration < 7 dayssingle blind
Germany
Schweizer (local urokinase), 2000
Local urokinase 100,000 IU/day infused continuously. Fibrinogen and plasminogen monitored. Heparin IV given concomitantly
versus
heparin IV, adjusted
patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 dayssingle blind
Germany
Schweizer (systemic urokinase), 2000
Systemic urokinase 5,000,000 IU/day over 4 hours for up to 7 days. IV heparin given concomitantly
versus
heparin IV, adjusted
patients with thrombosis of popliteal or more proximal veins confirmed by venogram at more than one level of duration < 9 dayssingle blind
Germany

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