Declining-dose Study of Reteplase Treatment for Lower Extremity Arterial Occlusions

Castañeda, Flavio; Swischuk, James L.; Li, Ruizong; Young, Kate; Smouse, Bob; Brady, Terry M.

doi:10.1016/s1051-0443(07)61949-6

Cited by 24 publications

(12 citation statements)

References 13 publications

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“…This appears to be true of tPA (61,65), UK (35,48), and rPA (71,74). Increasing the dose of a lytic agent may increase the speed of lysis, but not the percentage of complete lysis over time.…”

Section: Discussionmentioning

confidence: 95%

“…However, data in patients with acute myocardial infarction showed that rPA had similar safety and efficacy as tPA (28). In a prospective single-center study, 87 patients were treated with one of three continuous-infusion doses: 0.5, 0.25, or 0.125 U/h (71). In a prospective single-center study, 87 patients were treated with one of three continuous-infusion doses: 0.5, 0.25, or 0.125 U/h (71).…”

Section: Rpamentioning

confidence: 99%

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Catheter-directed Thrombolytic Therapy for Limb Ischemia: Current Status and Controversies

Razavi¹,

Lee²,

Hofmann³

2004

Journal of Vascular and Interventional Radiology

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Absence of urokinase from the United States market for the past 4 years has resulted in increasing experience with other plasminogen activators in catheter-directed thrombolytic therapy. The differences in the pharmacologic properties and biologic behavior of these agents may translate into clinical outcomes that are distinct. Some of these manifestations can be predicted based on the existing large clinical trials in the acute myocardial infarction literature. However, because of the fundamental differences in techniques and thrombolytic regimens, extrapolation of the coronary data may not always predict the performance of these agents in peripheral catheter-directed fibrinolysis. In this article, the current status of the available lytic agents in the treatment of limb ischemia is reviewed.

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Section: Discussionmentioning

confidence: 95%

Section: Rpamentioning

confidence: 99%

Catheter-directed Thrombolytic Therapy for Limb Ischemia: Current Status and Controversies

Razavi¹,

Lee²,

Hofmann³

2004

Journal of Vascular and Interventional Radiology

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“…An advisory panel from the Society of Interventional Radiologists recommended a maximum dose of 2 mg/h of Actilyse for a maximum total infusion of 40 mg (27). It has been shown that a dose > 1mg/h does not improve efficacy but does increase bleeding complications (24,5). In future, the use of a lower dose and a slow thrombolytic protocol may be considered in selected patients to avoid major complications.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Complications after Intraarterial Thrombolysis for Limb Ischemia: a 4 Year Study at a Single Centre

Ligers

Ivanova

Bergs

et al. 2016

Acta Chirurgica Latviensis

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3 Summary Introduction. The reason for using thrombolytic therapy is to eliminate vascular thrombosis and promote vascular permeability. Acute limb ischemia is associated with significant morbidity and mortality. ROCHESTER, STILE and TOPAS studies showed that thrombolytic therapy for acute limb ischemia decreases the rate of surgical interventions and significantly increases the rate of limb salvage. Aim of the Study. The purpose of this study is to assess the efficacy and outcomes of intra-arterial thrombolysis in the treatment of acute occlusions of the lower limb over a four-year period. Material and Methods. We analysed 103 patients who had been treated in our department. There were acute ischemias of stage IIa and IIb according to the Rutherford classification. The data prior to, and after thrombolysis was analysed. We used Alteplase as a thrombolytic agent (mean dose 62 mg ±23.5). Procedural success was based on angiographic and clinical outcomes. Statistics were calculated by SPSS 16. Results. The mean duration of symptoms prior to hospitalisation was 2.5 days (IQR 5-96 hours). The mean age at the time of thrombolysis was 63±11 for males 69±10 years for females. The success of intraarterial thrombolysis was defined by angiographic and clinical outcomes (successful in 86.4% and failed in 13.6%). Adjunctive angioplasty was performed on 39 (37.9%) patients, and immediate reconstructive surgery was required on 19 (18.4%) patients. The incidence of complications was 17,4 %, with the most common being-bleeding from the puncture side, the urinary tract or the gastrointestinal tract. Overall mortality was 8.7%. The women who required thrombolysis were older (p=0,034) and with a higher death rate (p=0.047). A CDT (catheter-directed thrombolysis) for an abdominal aorta thrombosis carries a significantly high mortality rate (p=0.00013). There were no statistically significant differences between the duration of symptoms and limb amputation and between other analysed data. Conclusions. Intraarterial thrombolysis is an effective treatment method in acute limb ischemia for selected patients, as long as accurate procedural monitoring is ensured. Thrombolysis often leads to the discovery of underlying vascular lesions. A CDT for an abdominal aorta thrombosis carries a significantly high mortality rate.

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“…This is usually defined as greater than 95% lysis with some degree of antegrade flow. 3,4,18,19,27 As for venous disease, some endpoints such as thrombolytic success are pertinent; however, because one of the main goals of venous thrombolysis is to prevent the long-term sequelae of chronic venous obstruction, acute endpoints such as 30-day limb salvage or amputation-free survival have less clinical relevance. In fact, clinical endpoints measuring the benefit of lytic therapy in the prevention of chronic venous insufficiency are difficult to reach because of the prolonged length of time it takes to manifest these clinical findings.…”

Section: Efficacymentioning

confidence: 99%

“…When performing catheter-directed arterial thrombolysis, amputation-free survival rates from 75 to 95% have been reported, and thrombolytic success rates are usually slightly lower, ranging from 67 to 87% regardless of the agent used. 3,4,19,26,27 Thrombolytic success when treating venous disease is typically lower; however, with careful selection of patients (i.e., those with iliac vein involvement) success is improved upon, especially when lysis is combined with angioplasty and stenting. 15 This strategy allows reasonable shortterm patency rates that have been speculated to contribute to improved long-term clinical success.…”

Section: Efficacymentioning

confidence: 99%

Differentiating Pharmacologic Agents Used In Catheter-Directed Thrombolysis

2005

Semin intervent Radiol

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The use of catheter-directed thrombolysis is a proven treatment for arterial ischemia, deep vein thrombosis, and severe pulmonary embolism. For arterial ischemia, thrombolysis has resulted in improved amputation-free survival and fewer subsequent surgeries to reestablish blood flow to the ischemic limb. The management of patients with thromboembolic diseases is complex, and the multiple thrombolytic drugs available to choose from compound this complexity. Although some believe the available thrombolytic agents are interchangeable, real biochemical differences exist that may prove otherwise. This article describes these pharmacologic differences and how they may affect the clinical practice of catheter-directed thrombolysis.

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Declining-dose Study of Reteplase Treatment for Lower Extremity Arterial Occlusions

Cited by 24 publications

References 13 publications

Catheter-directed Thrombolytic Therapy for Limb Ischemia: Current Status and Controversies

Catheter-directed Thrombolytic Therapy for Limb Ischemia: Current Status and Controversies

Outcomes and Complications after Intraarterial Thrombolysis for Limb Ischemia: a 4 Year Study at a Single Centre

Differentiating Pharmacologic Agents Used In Catheter-Directed Thrombolysis

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