A Decision Analysis of Streptokinase plus Heparin as Compared with Heparin Alone for Deep-Vein Thrombosis

• Published in: The New England journal of medicine Vol. 330; no. 26; pp. 1864 - 1869
• Main Authors: O'Meara, James J, McNutt, Robert A, Evans, Arthur T, Moore, Stacy W, Downs, Stephen M
• Format: Journal Article
• Language: English
• Published: Boston, MA Massachusetts Medical Society 30-06-1994
• Subjects: Anaphylaxis; Anticoagulants; Biological and medical sciences; Bleeding; Blood. Blood coagulation. Reticuloendothelial system; Central nervous system; Cerebral Hemorrhage - chemically induced; Clinical outcomes; Clinical trials; Confidence intervals; Death; Decision analysis; Decision Support Techniques; Edema; Embolism; Embolisms; Heparin; Heparin - administration & dosage; Heparin - adverse effects; Heparin - therapeutic use; Humans; Intravenous administration; Life expectancy; Life span; Medical sciences; Middle Aged; Nervous system; Patient Participation - statistics & numerical data; Patients; Pharmacology. Drug treatments; Postphlebitic Syndrome - chemically induced; Probability; Pulmonary Embolism - chemically induced; Randomized Controlled Trials as Topic; Risk; Sensitivity analysis; Sensitivity and Specificity; Streptokinase; Streptokinase - administration & dosage; Streptokinase - adverse effects; Streptokinase - therapeutic use; Stroke; Thrombolytic Therapy - adverse effects; Thrombophlebitis - drug therapy; Thrombosis; Treatment Outcome; Veins & arteries; Human; Drug combination; Cardiovascular disease; Anticoagulant; Thrombosis; Venous disease; Vascular disease; Chemotherapy; Streptokinase; Treatment; Glycosaminoglycan; Deep vein; Heparin
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJM199406303302605

It is uncertain whether patients with proximal deep-vein thrombosis are better treated with streptokinase plus intravenous heparin or with heparin alone
1
–
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. One review article
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citing no increased risk of major bleeding and one meta-analysis
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citing uncertain benefits and a relative risk of 2.9 for major bleeding have drawn opposite conclusions about the value of streptokinase. The National Institutes of Health issued a consensus statement supporting the use of streptokinase plus heparin
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. A more recent review article suggested that the decision to use streptokinase must be made on an individual basis, but it did not define the types . . .