SIR,-Your leading article on pulmonary infarction (7 May, p. 1129) was a most comprehensive account of different aspects of this condition, and was read with much interest.You mention that there is no longer any doubt of the efficacy of anticoagulant therapy in pulmonary infarction.It may be so at the present moment, but apart from anticoagulant therapy and pulmonary embolectomy, fibrinolytic therapy may also have a place in the treatment of pulmonary embolism; though so far there has been no extensive clinical trials preliminary reports of this therapy have been encouraging,' Browse and Jones' found striking clinical improvement in four of their patients treated with streptokinase, previous anticoagulation having failed to improve two of them.They recommend streptokinase as the treatment of choice in all except the moribund, in whom heparin should be tried.McNicol and Douglas' also suggest that the main indication for streptokinase is probably recent arterial occlusion and pulmonary embolism.-I am, etc.,
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Stevenson et al. (1966) studied this question.