Thrombolytic therapy was used for 57 patients with acute and sub-acute lower limb arterial ischaemia. In the first 34 patients a new
thrombolytic agent, acylated
plasminogen-
streptokinase complex (
BRL 26921) was assessed. Following this, 23 patients received low dose intra-arterial
streptokinase. The two thrombolytic regimes have been analysed retrospectively. There were differences observed between the two groups in the type of patients treated and in the severity of limb ischaemia. Of the patients receiving
BRL 26921, five (15%) had complete, and three (9%) partial lysis of the occluding
thrombus. Serious
bleeding occurred in six (18%) and minor
bleeding in ten (29%) patients. After 30 days, twelve patients (35%) had
limb salvage and eleven (32%) had died. Fifteen patients (65%) receiving intra-arterial
streptokinase had lysis of the occluding
thrombus. Minor
bleeding was observed in three patients (13%). After 30 days, 15 (65%) had
limb salvage and three (13%) had died. Patients receiving
BRL 26921 had a significantly greater reduction in plasma
fibrinogen and
plasminogen concentrations during treatment which may have accounted for the
bleeding complications. At the dose used,
BRL 26921 had no demonstrable
fibrinogen sparing effect. Improved lysis rates with fewer
bleeding complications might be achieved by reducing the dose of
BRL 26921. Low dose intra-arterial
streptokinase has been confirmed as a safe, effective method of thrombolysis in recent peripheral arterial ischaemia.