Cost-effectiveness of Intra-arterial Thrombolytic Therapy

Dacey, Lawrence J.; Dow, Richard W.; McDaniel, Martha D.; Walsh, Daniel B.; Zwolak, Robert M.; Cronenwett, Jack L.

doi:10.1001/archsurg.1988.01400340044008

Cited by 29 publications

(7 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19). At present, thromboly sis is expensive, due in pant to the fact that it is labor-intensive.In our study, approximately twice as much UK was administered to the high dose group (Table 4).…”

mentioning

confidence: 99%

Two urokinase dose regimens in native arterial and graft occlusions: initial results of a prospective, randomized clinical trial.

Cragg¹,

Smith²,

Corson³

et al. 1991

Radiology

View full text Add to dashboard Cite

The effects of two urokinase (UK) dose regimens on lysis time, lytic success, primary clinical success, and frequency of complications of peripheral thrombolysis were compared. Seventy-two intraarterial UK infusions were performed by means of standard catheter-directed infusion techniques in 63 patients with symptomatic peripheral arterial or bypass graft occlusions. Patients were prospectively randomized to high-dose (250,000 U/h for 4 hours and then 125,000 U/h) or low-dose (50,000 U/h) regimens. The mean time to complete lysis was 20.8, 26.0, 16.5, and 18.2 hours for the high-dose artery, low-dose artery, high-dose graft, and low-dose graft groups, respectively (P was not significant). Respective mean infusion durations were 27.1, 35.4, 22.2, and 25.3 hours. Clinical success was achieved in 65%-85% of cases. The frequency of complications was equivalent between groups, except for a higher frequency of minor bleeding complications in the high-dose group. The two urokinase dose regimens studied were equally effective in enabling peripheral thrombolysis.

show abstract

mentioning

confidence: 99%

Two urokinase dose regimens in native arterial and graft occlusions: initial results of a prospective, randomized clinical trial.

Cragg¹,

Smith²,

Corson³

et al. 1991

Radiology

View full text Add to dashboard Cite

show abstract

“…One report indicates a significantly higher effective cost per complete success of thrombolytic therapy when compared with surgery for treatment of arterial and graft occlusions. 65 This again, however, is a retrospective evaluation without randomization. The cost of thrombolytic therapy can be considerable due to the high cost of thrombolytic agent ($1000 to 2000 per treatment with urokinase) plus the associated cost of intensive care unit monitoring.…”

Section: Resultsmentioning

confidence: 99%

Thrombolysis in Arterial Bypass Grafts

1991

Semin Thromb Hemost

View full text Add to dashboard Cite

“…1,10,12,19,20 The phase I results of the TOPAS trial revealed a complete thrombolysis rate varying from 60% to 71% depending on the dosage of recombinant urokinase.21 Although there are no differences between high-dose/short duration and low-dose/long duration regimens in terms of efficacy, the total administered amount of thrombolytics is higher in the high-dose/short duration group with a higher rate of minor bleeding complications. '9 Our early success rate of 79.6% is comparable to that in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature the successful results of thrombolytic therapy varies from 37% to 85% in different series depending on definition of success, selection criteria for the patients treated, and the adjuvant therapy that follows the primary thrombolysis. 1,10,12,19,20 The phase I results of the TOPAS trial revealed a complete thrombolysis rate varying from 60% to 71% depending on the dosage of recombinant urokinase.21 Although there are no differences between high-dose/short duration and low-dose/long duration regimens in terms of efficacy, the total administered amount of thrombolytics is higher in the high-dose/short duration group with a higher rate of minor bleeding complications. '9…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results After Percutaneous Low-Dose Streptokinase Treatment for Acute Arterial Thrombosis

Yılmaz¹,

Vermeulen

Berg

et al. 2000

Vascular Surgery

View full text Add to dashboard Cite

The objective of this study was to evaluate the immediate efficacy and long-term results of a standard protocol of percutaneous, low dose, intraarterial streptokinase treatment in acute arterial thrombosis. This involved analysis of 48 consecutive patients with acute peripheral arterial thrombosis, treated with thrombolysis between October 1988 and August 1997. There were 30 men and 18 women patients, with an average age of 66.5 years. There was thrombosis of the native artery in 32, thrombosis of an aneurysm in seven, and graft occlusion in nine. After the occlusion was defined by arteriography, the low-dose streptokinase (10,000 units per hour) was continuously infused into the thrombosed segment following a bolus injection of 10,000 units. The initial success rate (defined as partial or complete lysis) was 79.6%. Additional therapy after lysis consisted of percutaneous transluminal angioplasty in 18, bypass surgery in six, anticoagulant therapy in seven, and amputation in seven owing to irreversible ischemic damage. One patient died of myocardial infarction before additional therapy. Of the 20.4% failures to fibrinolysis, two patients received bypass surgery, two surgical thrombectomy, three sympathectomy, and three had amputations. Local bleeding complications were seen in five (10%) patients. Only one patient needed surgical exploration. Allergic reaction to streptokinase was seen in five patients (10%) and fibrinolytic therapy was continued with urokinase in three. In the follow-up (1-107 months) eight patients died and three amputations were performed after a mean time of 17 months after thrombolysis owing to progression of arteriosclerosis. This resulted in a limb salvage rate of 76% after 1 year and 65% after 5 years (Kaplan-Meier). Low-dose, local, intraarterial streptokinase therapy is an effective preliminary step in management of acute arterial thrombosis. Especially with adequate additional treatment, it is possible to achieve satisfactory long-term patency rates.

show abstract

Cost-effectiveness of Intra-arterial Thrombolytic Therapy

Cited by 29 publications

References 16 publications

Two urokinase dose regimens in native arterial and graft occlusions: initial results of a prospective, randomized clinical trial.

Two urokinase dose regimens in native arterial and graft occlusions: initial results of a prospective, randomized clinical trial.

Thrombolysis in Arterial Bypass Grafts

Long-Term Results After Percutaneous Low-Dose Streptokinase Treatment for Acute Arterial Thrombosis

Contact Info

Product

Resources

About