3-3-1 Thrombolytic therapy
Streptokinase in 15 (36.6%), reteplase in 10 (24.3%), and alteplase in 7 (17.1%) episodes were used as a single agent, and 9 (21.9%) episodes were given a combination of two fibrinolytic agents consecutively. Complete hemodynamic and clinical success in absence of major complication was achieved in 28 (68.2%), partial success in 4 (9.7%), and ineffective thrombolytic therapy in 9 (21.9%) episodes, respectively. One in-hospital death (2.43%) occurred in a 70-year-old man unresponsive to thrombolytic and medial therapy due to worsening of heart failure symptoms. Eight (19.5%) episodes, which had partial or ineffective response, underwent subsequent surgery. Among episodes given reteplase alone (n = 10) or in combination with another fibrinolytic (n = 5), the total success rate was 86.6% (all episodes which received reteplase alone were successful), but there was no statistically significant difference among thrombolytic agents in this regard. Concerning major bleeding complications, there were no intracranial hemorrhage and gastrointestinal bleeding (GIB) (3 patients with a history of GIB or with a suspected recent upper and lower GIB symptoms underwent direct surgery). Retroperitoneal hematoma was noted in 2 (4.87%) episodes; one occurred in a 62-year-old lady after receiving 625,000-unit streptokinase in 10 hours without a loading dose, manifested as mild pelvic hematoma associated with abdominal wall hematoma, which hindered continuation of thrombolytic therapy; another limited mild retroperitoneal hematoma was observed in a 51-year-old man with the repeat of a second dose of rapid infusion of Alteplase after 48 hours. Documented minor bleeding was reported in 11 (26.8%) episodes, including notable ecchymosis (n = 5), epistaxis (n = 3), hemoptysis (n = 2), and hematuria (n = 1). Concerning thromboembolic events, there was 1 (2.43%) non-hemorrhagic thalamic infarct in a 23-year-old lady with a history of mitral valve replacement, but no AF rhythm. The mean of hospital stay was 13.6 ± 10 days.