Low-dose intravascular fibrinolytic therapy.

Totty, William G.; Gilula, Louis A.; McClennan, Bruce L.; Ahmed, P; Sherman, Lloyd F.

doi:10.1148/radiology.143.1.6461028

Cited by 94 publications

(21 citation statements)

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“…Overall success rates of local thrombolysis with percutaneous techniques and using SK or UK varied from 65 to 90% with a morbidity rate of 8 to 35%, and a procedure related mortality rate of 0.5 to 1.5% (16,31). Results of local thrombolysis did not differ when UK or SK were used (1, 24, 32), although some reported a higher success rate with UK (12,34).…”

Section: Discussionmentioning

confidence: 96%

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Percutaneous Local Arterial Thrombolytic Infusion

Goffette¹,

Kurdziel²,

Dondelinger³

1991

Acta Radiol

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All complications occurring in 55 local thrombolytic infusions performed for (sub)acute limb ischemia using streptokinase (SK) in 22 procedures and urokinase (UK) in 33 procedures were recorded. Success was achieved in 74.5% of the procedures. Major complications occurred in 31.8% of the procedures using SK, and in 12.1% of the procedures using UK (p = 0.07). Hemorrhage was the most common major complication and occurred in 27.2% of SK procedures and in 9.0% of UK procedures, a difference which was not significant. Overall, 30 day mortality was 16.3% and procedurerelated death was 1.8%. Moderate complications necessitating only the adjustment of drug regimen and minor complications without consequence were observed in 45.5% and 45.5%, respectively, of the SK procedures, and in 57.6% and 66.7% of the UK procedures.

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Section: Discussionmentioning

confidence: 96%

“…The higher fibrinogenolytic activity of SK compared to UK was confirmed in clinical practice (34). Fribrinogen of less than 1 gil or a thrombin time of 2 times the base value seemed to predispose to bleeding (22,31). A low fibrinogen level with a high level of FSP may result in formation of unstable fibrin platelet plugs (23,26).…”

Section: Discussionmentioning

confidence: 96%

Percutaneous Local Arterial Thrombolytic Infusion

Goffette¹,

Kurdziel²,

Dondelinger³

1991

Acta Radiol

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“…Subsequently, others have reported generally similar results that confirm the superiority of this method relative to larger intravenous infusions (1 00,000 IU/hr) [2][3][4][5][6]. The use of intraarterial low-dose urokinase has not been as extensively studied, and the results have not been encouraging.…”

Section: Mcnamara1mentioning

confidence: 89%

“…Infusions of 1/20th to i/i 0th the systemic dose have produced complete clot lysis in 25% and 40% of cases [3,4]. The use of an intraarterial loading dose of urokinase (75,000 CTA U over 20 mm) followed by a Continuous intraarterial infusion of 37,500 CTA U/hr for up to 4 days has produced a sustained lytic effect in only 1 5% [7].…”

Section: Mcnamara1mentioning

confidence: 99%

Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase

McNamara¹,

Fischer²

1985

American Journal of Roentgenology

313

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Ninety-three thromboembolic occlusions of peripheral arteries or grafts in 85 patients John R. Fischer1were treated with high-dose urokinase by direct intraarterial infusion. Urokinase was infused at 4000 lU/mm until antegrade blood flow was reestablished and then at 1000 or 2000 lU/mm until clot lysis was completed. Of the 93 infusions, 75 (81%) resulted in clinical improvement. The infusion therapy was incomplete in nine patients. The mean duration of the 84 completed infusions was 18 ± 20 hr, the incidence of complete clot lysis was 83%, and the incidence of clinical improvement was 89%. Significant bleeding, requiring transfusion, occurred during or after four of the urokinase infusions (4%).

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“…Recently there has been increased interest in the treat ment of patients with acute vascular occlusions with selec tive intraarterial infusion of low-dose fibrinolytic agents [1][2][3]. This method, introduced by Dotter et al in 1974 [4], is as effective as systemic fibrinolysis but has less morbidity.…”

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confidence: 99%

Visceral embolization during low-dose fibrinolysis of aortic graft occlusion

W¹,

Tisnado²,

Cho³

1983

American Journal of Roentgenology

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Recently there has been increased interest in the treat ment of patients with acute vascular occlusions with selec tive intraarterial infusion of low-dose fibrinolytic agents [1][2][3]. This method, introduced by Dotter et al. in 1974 [4], is as effective as systemic fibrinolysis but has less morbidity.Hemorrhagic complications with low-dose fibrinolysis are significantly reduced. Fever and allergic reactions due to the antigenicity of the drug are rare [5]. Distal embolization is a potential complication; however, it has not been of major DiscussionThe pharmacology, technique, and indications for lowdose intraarterial fibrinolysis have been well described re cently [1-3, 6]. Peripheral embolization during this proce dure has been reported or suspected in several cases [1, 3, 4]; however, to the best of our knowledge, none have had the catastrophic outcome that occurred in our patient.We speculate that the mechanism of this massive embo lization may have been the combination of fresh and old clot within the thrombus lysing at different sites and stages [7].The fresh clot may be lysed first. It is possible that the proximal systolic aortic pulsations may then have a "sand blasting" or "whirlpooling" effect, which may liberate the older and more resistant clot fragments. This is only conjec ture and could be studied in vitro and in animal models.Once these clot fragments are liberated, it is clear that they could then be carried peripherally through the vessels of greatest outflow and least resistance, which in this case, since the aorta was occluded, were the renal and superior mesenteric arteries.An initial loading dose of streptokinase of 2000 U/min during the first hour has been advocated recently [8]. We have been giving a loading dose routinely to our patients.The loading dose assists in neutralizing the circulating anti bodies present in most individuals and allows a rapid as sessment of the potential lytic effects. It is tempting to postulate that the loading dose may have accelerated the lysis of fresh clot, thereby increasing the likelihood of pe-

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Low-dose intravascular fibrinolytic therapy.

Cited by 94 publications

References 0 publications

Percutaneous Local Arterial Thrombolytic Infusion

Percutaneous Local Arterial Thrombolytic Infusion

Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase

Visceral embolization during low-dose fibrinolysis of aortic graft occlusion

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