[Haemorrhagic complications using streptokinase during 98 treatments. Place of the biological surveillance (author's transl)].
Streptokinase was administered to 98 patients, 75 of them with arterial occlusion of the limbs, in accordance with the classical protocol of high and continuous doses (150,000 international units per hour for 48 to 78 hours after an initial standard dose of 500,000 units). There were a total of 15 haemorrhagic complications: --related to a non-respected contraindication (1 case) --traumatic (4 cases) --spontaneous (10 cases), responsible for or contributing to a fatal outcome in 4 instances. In addition, there were 13 spontaneous or provoked haemorrhagic side effects. Retrospective analysis of laboratory results shows that it is difficult to predict haemorrhage: the degree of fibrinopaenia and fibrin breackdown product levels are not closely related to the onset of bleeding. Nevertheless, the combination of a residual fibrin level of less than 1.50 g/l approximately with an amount of fibrinogen broken down (difference between fibrinogen levels before treatment and during treatment) of more than 3 grams was present in the great majority of patients in whom complications developed. The absence of bleeding seen when plasma thrombolytic activity, assessed by the Blix test, is inadequate, suggests the existence of a relationship between biological effectiveness and the risk of haemorrhage. In practice, apart from strict observation of contraindications, the risk of haemorrhage must be born in mind when the therapeutic decision is made. Careful clinical surveillance is today more important than laboratory studies in the prevention of haemorrhagic complications, the price which must be paid for the thrombolytic activity of streptokinase. The latter is capable of acting not only upon the vascular obstruction but also upon haemostatic clots.