Seven short-term studies involving a total of 222 patients were included in the analysis of thrombolytic efficacy. Five studies (number of participants not stated) were included in the analysis of long-term efficacy in preventing abnormalities in venous function or post-phlebitic syndrome. Four studies with a total of 152 patients were included in the analysis of minor and major bleeding.
The estimated ORs for the analysis of thrombolytic efficacy for each study ranged from 2.29 to 15.56. The superiority of streptokinase was only significant in one study. Significantly more steptokinase recipients achieved thrombolysis than recipients of heparin alone (summary OR 6.24, 95% CI: 3.62, 10.78). There was no significant difference in clinical improvement between the recipients of streptokinase and the recipients of heparin.
Data from studies with long-term follow-up showed heterogeneity (chi-squared 8.03, d.f.=3, p<0.05). One study was identified as an outlier and excluded from the analysis, and the test for homogeneity subsequently yielded a p-value of greater than 0.05 (chi-squared 5.3, d.f.=2). The meta-analysis of the remaining four studies showed that streptokinase recipients were significantly less likely to have post-thrombotic changes (summary OR 0.40, 95% CI: 0.18, 0.88) and post-phlebitic changes (summary OR 0.32, 95% CI: 0.12, 0.86) in phlebographic evaluation. The frequency of major bleeding was significantly higher among streptokinase recipients than recipients of heparin alone (summary OR 3.78, 95% CI: 1.26, 11.32). There was no significant difference between streptokinase and heparin for the incidence of minor bleeding or PE.