[Moderate doses of urokinase (UK) in the treatment of myocardial infarct and pulmonary embolism].

Since 1972, UK in moderate doses have been used in the treatment of severe or massive pulmonary emboli (PE) and of myocardial infarction (MI) present for less than 24 hours. The standard dose is 2,700,000 CTA units per 24 hours administered as a continuous infusion, in association with appropriate heparin therapy and a platelet anti-aggregant agent in order to palliate the hyperagregant effects of thrombolytic drugs. Laboratory surveillance has now been greatly simplified and is limited to that of the associated heparin therapy. In the acute phase of myocardial infarction, a personal randomised study of 120 cases consisting of 60 treated with heparin + UK and 60 with heparin alone showed that UK decreased mortality, cardiac arrhythmias and cardiac failure. Comparative studies at lower doses have failed to show any significant difference between the two groups of patients treated and the authors feel that the use of UK should be reserved for very recent infarctions in young subjects. In PE, the effectiveness of UK was assessed in 180 severe cases. It depended upon the length of time for which the thrombus had been present. Before the 5th day, there was early average revascularisation of 40 p. 100 of the avascular territory. Mortality was reduced to 15 p. 100 and at the 3rd week 32 p. 100 of the survivors had complete revascularisation, and 68 p. 100 partial but adequate revascularisation. Adjuvant therapy such as a combination of Lysil Plasminogen and/or defibrinating agent currently make it possible to reinforce therapeutic thrombolysis.