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Fifty-four patients with deep venous thrombosis diagnosed on the basis of venographic studies were treated by four physicians using the same protocol but acting independently. In the early part of the study all patients were treated with streptokinase; in the latter part patients were randomized and treatment was either heparin or streptokinase. Of 40 patients who. received streptokinase, 22 were randomized and 18 were nonrandomized. Both drugs were administered by continuous IV infusion for 72 hours. Patients treated with streptokinase in the early stages of disease did very well; 90% of patients treated within five days of the onset of clinical symptoms and 75% treated within two weeks of onset showed marked improvement on post-treatment venograms. Only one patient who was treated with heparin showed a good result. Clinical results were similar in both groups. The incidence of important complications, such as significant bleeding and pulmonary emboli, was the same with both modalities. Fever of more than 101 F developed in about 50% of patients treated with streptokinase but in only one patient treated with heparin. We conclude that streptokinase is very effective in treating patients with acute deep venous thrombosis.