Intrapulmonary artery infusion of urokinase for treatment of massive pulmonary embolism: A review of 26 patients with and without contraindications to systemic thrombolytic therapy

Abstract

SummaryBackground: Pulmonary emboli (PE) are a common event seen in over 600,000 patients a year. Occurring suddenly, PE often result in a high rate of mortality. To combat the high rate of mortality, more aggressive therapies including the use of thrombolytics are often indicated. The use of intrapulmonary artery infusion of urokinase has been shown to promote rapid resolution of emboli and restoration of normal pulmonary hemodynamics.Ilypotlzesls: The study was undertaken to review the effectiveness and safety of pulmonary artery infusion of urokinase in 26 patients with and without contraindications to the use of systemic thrombolytic therapy.Methods: We reviewed the outcomes of 26 patients who received infusion of urokinase, using a usual loading dose of 4,000 U/kg body weight given as a bolus, followed by 4,000 U k g h for 12 to 24 h, using either/or unilateral or bilateral infusions. Pulmonary angiograms were obtained prior to and following the urokinaqe infirsions.Results: Intrapulmonary artery infusion of urokinase was given to 26 patients, 9 of whom had contraindications to the use of systemic thrombolytic therapy. Six patients were recent post operative, one was receiving oral anticoagulants, one was receiving chemotherapy with bleeding complications, and one had received cardiopulmonary resuscitation. Twenty of the patients returned to their baseline state (normal heart rate, blood pressure, and pOz), one was minimally improved, and

Successful Treatment of Peripartum Massive Pulmonary Embolism with Extracorporeal Membrane Oxygenation and Catheter-Directed Pulmonary Thrombolytic Therapy

“…The primary goal of a catheter-based approach to thrombolytic therapy is to improve the rate and efficiency of clot dissolution, with minimal risk of systemic fibrinolysis. This approach has the advantage of immediate removal or fragmentation of the obstructing clot, while avoiding the potential bleeding complications of systemic therapy 12 , but no clear advantage of catheter-directed thrombolysis compared with intravenous thrombolysis has been shown 13 . In non-pregnant patients with acute pulmonary embolus, no clinical trial or metaanalysis has been large enough to conclusively demonstrate that thrombolytic therapy followed by anticoagulation confers a mortality benefit compared with anticoagulation alone [14][15][16] .…”

Multiorgan paradoxical embolism consequent to acute pulmonary thromboembolism with patent foramen ovale: a case report

“…Intrapulmonary thrombolisis is indicated only in selected cases, when the drug should be concentrated more in a specific area, or in presence of contraindications to systemic therapy and additionally the concentrated dose may provide a faster resolution of the clot. However, our patient had the necessity of a systemic distribution of the drug [ 17 ].…”

Deep Venous Thrombosis After Radical Pelvic Surgery

“…Thrombolytic therapy has the advantage of preserving the pulmonary microcirculation after PE and decreasing the possibility of post-thrombotic syndrome (PTS) following DVT (Linn et al, 1988). Intrapulmonary artery infusion of urokinase in extensive PE has been found to be safe and effective in treatment of patients with and without contraindication to the use of systemic thrombolytic therapy (McCotter et al, 1999). With the recommended dose, thrombolytic therapy produces significant and rapid resolution of pulmonary emboli with a low morbidity and mortality rate.…”

“…In addition, pulmonary artery catheterization with the administration of thrombolytic agents has been tried as previously mentioned (McCotter et al, 1999).…”