The differences in reported mortality rates for thrombolytic therapy in different papers in the literature probably reflects differences in patient populations and in the philosophy of use of thrombolytic therapy. Salvage thrombolytic therapy. Our published results have used 24-48 hour infusions of streptokinase or urokinase. This means that the patient must be stable enough to survive 24-48 hours before the valve is opened. Critically ill patients should therefore be taken to surgery if there is a significant risk of death within 24-48 hours.
Thrombolytic therapy is used as an elective therapy.
In these centers, less sick patients are operated on and the most gravely ill are given thrombolytic therapy. The higher mortality associated with thrombolytic therapy reported in these series is probably due to this philosphy of use as a last resort. The protocol in the Physician's Desk Reference for administration of Urokinase for Pulmonary Embolism is followed. Silber H, Khan S, Matloff J, et al. Throbmolytic therapy for prosthetic cardiac valve thrombosis.