RESUMEN
To test the efficacy of thrombolytic therapy in massive pulmonary embolism, we conducted a prospective randomized controlled trial. Eight patients were randomized to receive either 1,500,000 IU of streptokinase in 1 hour through a peripheral vein followed by heparin or heparin alone. All patients had major risk factors for deep vein thrombosis (DVT) and were considered to have high clinical suspicion for pulmonary embolism (PE). At baseline all patients had a similar degree of systemic arterial hypotension, pulmonary arterial hypertension, and right ventricular dysfunction. The time of onset of cardiogenic shock in both groups was comparable (2.25 +/- 0.5 hours in the streptokinase group and 1.75 +/- 0.96 hours in the heparin group). The four patients who were randomized to streptokinase improved in the first hour after treatment, survived, and in 2 years of follow-up are without pulmonary arterial hypertension. All four patients treated with heparin alone died from 1 to 3 hours after arrival at the emergency room (p = 0.02). Post-thrombolytic therapy the diagnosis of PE was sustained in the streptokinase group by high probability V/Q lung scans and proven DVT. A necropsy study performed in three patients in the heparin group showed massive pulmonary embolism and right ventricular myocardial infarction, without significant coronary arterial obstruction. The results indicate that thrombolytic therapy reduces the mortality rate of massive acute pulmonary embolism.
RESUMEN
As of August 1988, 1,628 cases of AIDS had been reported in Mexico, of which 12% were ascribed to transmission through blood. Of the 201 subjects infected by blood, 159 (79%) were infected through transfusions. The relatively high number of such cases was found to be associated with a prevalence of HIV infection of 7% among paid donors as compared with a prevalence of 0.1% among volunteer donors. A National AIDS Prevention Committee has been established in Mexico, and amendments to the country's General Health Law mandate compulsory screening to detect HIV infection among all donors and prohibit the sale of blood. A national network of screening laboratories was established and an educational campaign initiated among health personnel. Evaluation of this program shows that the current frequency of HIV infection in donors is 0.04%.