Thrombolytic Treatment During Pregnancy

The treatment of occlusive deep vein thrombosis during pregnancy with fibrinolytic agents as streptokinase and urokinase is still controversial. The main points of controversy are retroplacental bleeding, fetal heart rate acceleration and malformations of the fetus. The main author conducted 122 therapeutic fibrinolytic treatments during pregnancy since 1961. The earliest beginning of treatment was the 14th week, the latest the 38th week of pregnancy. The indications to all treatments in these cases was an acute thrombotic occlusion of one or both ileofemoral veins in pregnant women. The diagnosis was established by clinical signs and, since 1975 by ultrasonography (n = 63). The treatment regimen was previously designed with the use of medium large doses of streptokinase in prolongation of an initially high dosage (1000,000 IU), later on 63 cases were treated by the following scheme: Initial dosage 1.5 - 1000,000 IU streptokinase within 30 minutes i.v. by monitored infusion, followed by an hourly dosage of not more than 250,000 IU streptokinase for 24 to 48 hours. An initial raise of body temperature occured in 28% of all cases. The fetal heart rate was watched by cardiotocography so far the pregnancy was beyond the 28th week. The success rate of all cases was 72%, indicating the complete restoration of the vessel's patency, 18% responded partially, 10% did not respond at all. 55% of all cases were examined by phlebography some days after delivery, the others were checked by clinical examination only or by ultrasonography respectively. The postfibrinolytic treatment in all cases consisted in the application of heparin in the dosage of 20,000 to 40,000 IU/24 hours for at least two weeks, approximately 60 percent of the cases received oral anticoagulants for further five weeks. Complications: One premature rupture of the membranes with healthy child, one premature separation of the well situated placenta with fatal fetal outcome, two severe bleedings during the treatment which made ar. emergency delivery by cesarean section necessary. Streptokinase was then neutralized by AM- CA. No fetal malformations were observed.