Intended for healthcare professionals


Streptokinase versus alteplase and other treatments for acute and delayed thrombolysis of blood stains in clothing

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1554
  1. C K Pager, resident medical officer (ckpager{at}
  1. Royal Prince Alfred Hospital, Sydney, Australia 2050


Objective: To assess the usefulness of heparin, alteplase, and streptokinase in removing blood stains.

Design: Randomised controlled trial.

Setting: Hospital laundry.

Interventions: Blood stains were allocated to treatment with alteplase, streptokinase, heparin, a commercial enzymatic stain remover, or no treatment at all after three or seven hours and then washed in hot or cold water two hours later.

Results: Both hot water and early treatment were strongly associated with improved stain removal. All four treatments were associated with a worse outcome than no treatment at all, although for streptokinase this trend did not reach significance. The commercial stain remover gave the worst results of all treatments tested.

Conclusions: Contrary to popular wisdom, hot water is much more effective than cold in removing blood stains. Methodologically rigorous research and evidence based principles are needed within the laundry industry, and the role of thrombolytic drugs should be assessed further.


  • Funding The alteplase and streptokinase were donated by Boehringer Ingelheim and Aventis Pharma respectively.

  • Competing interests None declared.

View Full Text