A New Intra Arterial rt-PA Dosage Regimen in Peripheral Arterial Occlusion: Bolus Followed by Continuous Infusion

Juhan, C.; Haupert, Serge; Miltgen, Gilles; Girard, Nadine; Dulac, P

doi:10.1055/s-0038-1648203

Cited by 17 publications

(4 citation statements)

References 5 publications

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“…Some reports, however, show an increased rate of bleeding complications compared with continuous infusion, 43 whereas others do not. [44][45][46] There is concern about distal embolization with either method due to clot fragmentation and close monitoring is needed. 47 The graded infusion technique was popularized with publication of the high-dose UK infusion method of McNamara and Fischer, 32 but it has not been applied widely using tPA derivatives because of bleeding risk concerns.…”

Section: Infusion Methods and Dosagesmentioning

confidence: 99%

Catheter-Directed Thrombolysis for Acute Limb Ischemia

Morrison

2006

Semin intervent Radiol

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Acute limb ischemia is a potentially life-threatening clinical event. Thrombosis in situ, bypass graft thrombosis, and embolic occlusion are the three major precipitating events leading to acute limb ischemia. Management of acute ischemia depends on the clinical status of the affected limb and patient comorbidities. Catheter-directed thrombolysis (CDT) is the treatment of choice for patients with relatively mild acute limb ischemia (Rutherford categories I and IIa) with no contraindications to thrombolytic therapy. Patients with severe acute limb ischemia (Rutherford category IIb) need emergent revascularization. CDT should be considered, nonetheless, if the relative risks compared with primary operation are favorable. CDT is a life-and limb-saving treatment for many patients despite limitations of efficacy and associated complications. This article is a review of the etiology of acute arterial occlusion; clinical triage of patients presenting with acute limb ischemia; catheter guide wire techniques, pharmacological agents, and devices in current use for CDT; as well as the outcomes of CDT.

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Section: Infusion Methods and Dosagesmentioning

confidence: 99%

Catheter-Directed Thrombolysis for Acute Limb Ischemia

Morrison

2006

Semin intervent Radiol

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“…3 ,4 Others have also recently reported improvement in lysis time with a bolus infusion oft-PA, although patient numbers in both reports are small. 10,11 Serious bleeding was encountered in 1 of 12 patients treated with bolus plus infusion t-PA by Buckenham et al 11 and in none of seven patients cited by Juhan et allO In contrast to these reports, hemorrhage has been a major concern in our series. Serious bleeding was encountered in eight patients (35%), not just at or adjacent to the catheter entry site but also at a distance.…”

Section: Discussionmentioning

confidence: 49%

Thrombolysis with tissue-plasminogen activator: Results with a high-dose transthrombus technique

Ward

Andaz²,

Bygrave³

1994

Journal of Vascular Surgery

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“…By "lacing" the entire length of the thrombus at the onset of the procedure with a high-dose bolus of thrombolytic agent while withdrawing a thin catheter (either one with an endhole or one with multiple sideorifices with or without a tip-occluding wire) from the distal to the proximal end of the occlusion, acceleration of lysis is pursued (6)(7)(8)(9)(10).…”

Section: Techniquesmentioning

confidence: 99%

Thrombolysis in Arterial Occlusion

Verhaeghe¹

1999

Thromb Haemost

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SummaryIntra-arterial thrombolytic therapy has replaced systemic intravenous infusion of thrombolytic agents as a treatment modality for arterial occlusion in the limbs. Several catheter-guided techniques and various infusion methods and schemes have been developed. At present there is no scientific proof of definite superiority of any agent in terms of efficacy or safety but clinical practice favours the use of urokinase or alteplase. Studies which compared thrombolysis to surgical intervention suggest that thrombolytic therapy is an appropriate initial management in patients with acute occlusion of a native leg artery or a bypass graft. Underlying causative lesions are treated in a second step by endovascular or open surgical techniques. Severe bleeding is the most feared complication: the risk of hemorrhagic stroke is 1-2%.

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A New Intra Arterial rt-PA Dosage Regimen in Peripheral Arterial Occlusion: Bolus Followed by Continuous Infusion

Cited by 17 publications

References 5 publications

Catheter-Directed Thrombolysis for Acute Limb Ischemia

Catheter-Directed Thrombolysis for Acute Limb Ischemia

Thrombolysis with tissue-plasminogen activator: Results with a high-dose transthrombus technique

Thrombolysis in Arterial Occlusion

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