TRATTAMENTO FIBRINOLITICO LOCO-REGIONALE DELLA TROMBOSI VENOSA PROFONDA IN FASE NON ACUTA, COMPLICATA DA EMBOLIA POLMONARE RECIDIVANTE

We report our experience in local fibrinolytic treatment (urokinase) of ilio-femoral thrombosis during the non-acute phase (dating not less than six days), and complicated with recurrent severe pulmonary embolism. The loading dosage was 1500 U/kg and the maintenance dosage 1500 U/kg/h. The thrombolysis was complete in one case and over 50% in three cases. The dyspnea and venous stasis clinical signs promptly improved with normalization of blood-gas measurements. By contrast, lung scannings did not detect any significant pulmonary perfusion variations. Neither important side effects nor recurrent pulmonary embolisms were seen, as well as deep venous re-thrombosis. In conclusion, local fibrinolytic treatment of deep venous thrombosis complicated with recurrent pulmonary embolisms can be suggested as a potentially effective and safe treatment. It may be valid even in late cases, where heaprin was ineffective.