Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding

Abstract

Abstract. The present study aimed to examine the feasibility of catheter-directed thrombolysis (CDT) using continuous infusion of low-dose urokinase in combination with low molecular weight heparin (LMWH) for acute iliofemoral venous thrombosis. This retrospective analysis included patients with symptomatic acute iliofemoral venous thrombosis who received CDT using continuous infusion of low-dose urokinase in combination with LMWH within the past four years. Urokinase was administered at 1x10 4 U/h and 2x10 4 U/h in patients at high-risk and low-risk of bleeding, respectively. Measurements included urokinase dosage, duration, clinical outcomes and CDT-related complications. A total of 46 patients were included (high-risk, n=17; low-risk, n=29). In the high-risk patients, 64.7% experienced dissolution of ≥50% thrombi after a median CDT duration of 8 days (range, 6-10 days) and median total urokinase dose of 1.92x10 6 units (range, 1.44-2.4x10 6 units). In the low-risk patients, 82.8% achieved dissolution of ≥50% thrombi after a median CDT duration of 7 days (range, 4-10 days) and a median total urokinase dose of 3.36x10 6 units (range, 1.92-4.80x10 6 units). Remission of clinical symptoms after CDT was achieved in 15 (88.2%) and 28 (96.6%) cases in high-risk and low-risk patients, respectively. No treatment-associated pulmonary embolism or major bleeding was observed. Three (6.5%) subjects (high-risk, n=1; low-risk, n=2) experienced minor bleeding. In conclusion, continuous infusion of low-dose urokinase via CDT in combination with LMWH is effective and safe for acute iliofemoral venous thrombosis in patients with one or more risk factor for bleeding.

Feasibility of low‑dose infusion of alteplase for unsuccessful thrombolysis with urokinase in deep venous thrombosis

“…Thus, it is difficult to accurately determine the therapeutic efficacy of the two fibrinolytic agents on the basis of these two superficial rates alone. A previous study reported the successful lysis rate of a low-dose urokinase infusion method as 82.2% (9), which was consistent with the results of the aforementioned two studies. The lack of success of thrombolysis with urokinase in this group may be attributable to several factors.…”

“…During the remedial thrombolysis with alteplase, no symptomatic PE or major bleeding complications occurred, and the rate of minor bleeding complications was only 15.7%. Therefore, compared to a previous report using urokinase alone, additional rescue thrombolysis with alteplase for unsuccessful thrombolysis with urokinase did not increase the bleeding risk (9). However, as the present study was limited by the small number of cases, this conclusion requires validation in controlled studies.…”

“…Several factors are associated with the lysis rate of thrombus, such as the duration of thrombolysis, doses of lysis-inducing agents and the mode of delivery. However, a previous study reported that the proportion of patients in which a lysis rate ≥50% was achieved reached a maximum of 82.8%, when mean doses of 3-4 million units and an infusion time of <7 days were used (9). In the present study protocol, the duration and doses of treatment used in some patients who were unresponsive to initial thrombolysis might not have reached the threshold of thrombus lysis.…”

“…Other comprehensive interventional treatment methods were the same as reported previously by Chen et al (9) and Shi et al (10). Following CDT, an 8-14-mm diameter balloon catheter (C.R.…”

Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis&nbsp;

“…11 In rare cases with high risks of bleeding, the estimated dose might be reduced by half. 12 Coagulation function was tested daily. Infusion rate of urokinase dosage was adjusted according to Fibrinogen (FIB) concentration: infusion rate slowed by 50% if plasma FIB concentration decreased to <1.5 g/L; CDT was suspended and restarted with a rate slowed down by 50% if plasma FIB concentration dropped to <1.0 g/L.…”