Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator (rt-PA) in Acute Lower Limb Ischaemia

Flis, Vojko; Kobilica, Nina; Bergauer, Andrej; Mrdža, Božidar; Milotič, Franko; Štirn, Barbara

doi:10.1177/147323001103900346

Cited by 2 publications

(3 citation statements)

References 18 publications

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“…Two studies were excluded because they were of insufficient quality. 15,45 Meta-analysis shows favoring of limb salvage with Angiojet at the 30-day, 6-month, and 1-year follow-ups (Fig 6, A-C). Statistical significance was only found at Rotarex mechanical thrombectomy system versus r-tPA.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 98%

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A systematic review and meta-analysis of endovascular and surgical revascularization techniques in acute limb ischemia

Veenstra

Laan

Zeebregts

et al. 2020

Journal of Vascular Surgery

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Background: The initial treatment of patients with acute limb ischemia (ALI) remains undefined. The aim of this article was to compare the safety and effectiveness of catheter-driven thrombolysis (CDT) with surgical revascularization and evaluate the various fibrinolytic agents, endovascular, and pharmacochemical approaches that aim for thrombectomy.Methods: PubMed, Embase, and the Cochrane Library were searched for studies on the management of ALI by means of surgical or endovascular recanalization, returning 520 studies. All randomized, controlled trials, nonrandomized prospective, and retrospective studies were included comparing treatment of ALI.Results: Twenty-five studies, investigating a total of 4689 patients, were included for meta-analysis spread across nine different comparisons. No differences were found in limb salvage between thrombectomy and thrombolysis. More major vascular events were seen in the thrombolysis group (6.5% compared with 4.4% in the surgically treated group; odds ratio [OR], 0.33; 95% confidence interval [CI], 0.13-0.87; P ¼ .02; I 2 ¼ 20%). Comparable limb salvage was found for high-and low-dose recombinant tissue plasminogen activator (r-tPA). No significant differences were found in major vascular event between low r-tPA (14%) and high r-tPA (10.5%; P ¼ .13). The 30-day limb salvage rate was 79.7% for r-tPA treatment and 60.4% for streptokinase (OR, 3.14; 95% CI, 1.26-7.85; P ¼ .01; I 2 ¼ 0%). AngioJet showed more limb salvage at 6 months compared with r-tPa (OR, 2.21; 95% CI, 1.17-4.18; P ¼ .01; I 2 ¼ 0%).Conclusions: Both CDT and surgery have comparable limb salvage rates in patients with ALI; however, CDT is associated with a higher risk of hemorrhagic complications. No conclusions can be drawn regarding the risk of hemorrhagic complications regarding thrombolytic therapy by means of r-tPA, streptokinase, or urokinase. Insufficient data are available to conclude the preference of using a hybrid approach, ultrasound-accelerated CDT, heated r-tPA. or novel endovascular (rheolytical) thrombectomy systems. Future trials regarding ALI need to be constructed carefully, ensuring comparable study groups, and should follow standardized practices of outcome reporting.

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Section: Journal Of Vascular Surgerymentioning

confidence: 98%

“…All were of sufficient quality and eligible for meta-analyses. Five were randomized controlled trials, [9][10][11][12][13] four retrospective, [14][15][16][17] and one nonrandomized prospective study 18 (Table I). The 30-day limb salvage data were reported by all studies.…”

Section: Surgery Versus Cdtmentioning

confidence: 99%

A systematic review and meta-analysis of endovascular and surgical revascularization techniques in acute limb ischemia

Veenstra

Laan

Zeebregts

et al. 2020

Journal of Vascular Surgery

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“…2,30 Several studies report the use of intravenous thrombolysis is quite safe with a successful reperfusion of about 76-77% without major bleeding complications. 31,32 But the number of samples in these studies is small. Thrombolytic drugs work indirectly to destroy fibrin by converting plasminogen to plasmin.…”

Section: Managementmentioning

confidence: 99%

Revascularization of Acute Limb Ischemia

Setianto

Ahmad

2020

Acta Cardiol Indones

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Acute limb ischemia (ALI) is a medical emergency which can lead to loss of limb and even death. The outcomes are depending on the immediacy and completeness of revascularization or reperfusion. Generally, the considered a golden period in the management ALI is 6 hours. Unfortunately, the handling of patients with ALI is often too late. Currently there are several methods of revascularization such as thrombolysis (catheter directed thrombolysis), percutaneous and open surgical mechanical thrombectomy. The selection method where is the best revascularization remains controversial. Some research suggest that outcomes did not differ between thrombolysis and surgical therapy.

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Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator (rt-PA) in Acute Lower Limb Ischaemia

Cited by 2 publications

References 18 publications

A systematic review and meta-analysis of endovascular and surgical revascularization techniques in acute limb ischemia

A systematic review and meta-analysis of endovascular and surgical revascularization techniques in acute limb ischemia

Revascularization of Acute Limb Ischemia

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