Outcome of Treatment of Deep-Vein Thrombosis with Urokinase: Relationship to Dosage, Duration of Therapy, Age of the Thrombus and Laboratory Changes

Abstract

SummaryForty-one patients with phlebographically proven DVT of the popliteal, femoral or iliac veins were treated with different regimens of urokinase (UK) given by continuous intravenous infusion. The four groups were comparable with respect to localization, extension and estimated age of the thrombi. Another phlebographic picture was taken within 48 hr after the end of UK infusion. Substantial lysis had occurred in 2 of 10 patients treated with 1500 U/kg/h for 2 days, in 4 of 11 treated with 2500/U/kg/h for 3 days, in 2 of 10 treated with 2500 U/kg/h for 7 days and in 4 of 10 treated with 4000 U/kg/h for 4 days. Only thrombi younger than 8 days could be lysed, with 61% (8/13) rate of lysis for thrombi less than 5 days old. Bleeding complications were observed more frequently with the higher doses and longer durations of therapy. The four treatment regimens all induced dose-dependent changes in fibrinogen, fibrin(ogen) degradation products, plasminogen and antiplasmin. Neither pre- nor postinfusion values of these parameters could differentiate patients with lysis from those without lysis. It is concluded that UK can provoke a high rate of thrombolysis of DVT treated early after the appearance of symptoms but that there is no relationship between UK-induced modifications of fibrinolysis and the outcome of therapy.

The Role of Vitrectomy Assisted rt-PA Injection for the Management of Branch Retinal Vein Occlusion: Case Report

“…15 Garcia-Arumi et al performed sheathotomy before fluid-air exchange and t-PA infusion, which in addition to decompression can change the internal limiting membrane and the barriers of the retinal circulation; thus the reported success from this author may be related to the combination of t-PA injection with mechanical manipulations facilitating its access to the intravascular space. 3 The age of vein occlusion may also be a limiting factor and there is evidence in the literature that only thrombi of recent development can be lysed; 16 the thrombosis of our patient had a mean duration of 18.3 days (range 14-25 days), which can be considered relatively short, in comparison to literature. Another reason for failure may be that venous occlusive disease is due to sclerotic phenomenon from the adjacent or crossing sclerotic arteriole; therefore, even if rt-PA crosses the venous wall, the mechanism of fibrinolysis alone may not be effective in relieving the occlusion.…”

Results of the PHLEFI Study (PHLEbothrombosis-FIbrinolytic therapy): A prospective, multicenter study of the fate of 1498 patients receiving fibrinolytic therapy for deep vein thrombosis

“…Study of the corresponding data published previously by other groups reveals that lower incidences of cerebral bleeding were reported for UHSK [5][6][7][8][9][10][11][12][13][14] and SK [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] therapy, whereas higher incidences were reported for UK therapy [28,30,33,34,35,36].…”

Extended deep vein and inferior vena cava thrombosis in a 15-year-old boy: Successful lysis with recombinant tissue-type plasminogen activator 2 weeks after onset of symptoms

“…Anatomical malformations can also form a predisposing cause for thrombosis [17] as shown in the presented case. Although the thrombosis was already 2 weeks old, and most authors agree that a delayed therapy is the main reason for therapeutic failure [2,15,16,19], a fibrinolytic therapy was carried out in order to restore normal kidney function, rt-PA was used because of its potential advantages with a more "localized" effect due to its fibrin specifity [9,11,12] and it has been successfully used in children without any complications [7,8,9,15,16,22]. We administered rt-PA in a m a x i m u m dosage of 0 .…”