Cholesterol Emboli and Streptokinase Therapy

Abstract

To the Editor. —Drs Schwartz and McDonald1recently described two cases of cholesterol embolization syndrome occurring after receiving intravenous streptokinase therapy for myocardial infarction. I disagree with them about their conclusion. Cholesterol embolization syndrome occurs spontaneously but has been described after vascular surgery, arteriographic procedures2,3including coronary angiography,2and oral anticoagulant therapy including warfarin sodium.4Extensive atherosclerosis, systemic hypertension, and diabetes mellitus represent other risk factors. Furthermore, some of these conditions are frequently associated.3 In the first case reported by Drs Schwartz and McDonald, coronary arteriography preceded streptokinase treatment before the occurrence of the cholesterol embolization syndrome. In the second case, after the streptokinase had been given, coronary arteriography and two weeks of warfarin therapy followed before the cholesterol embolization syndrome developed. There is therefore no reason to blame the intravenous streptokinase therapy, and so the title of this article is inappropriate and misleading. Cholesterol