Recombinant human tissue-type plasminogen activator is an effective agent for thrombolysis of peripheral arteries and bypass grafts: Preliminary report

Abstract

The efficacy, safety, and effects on hemostasis and coagulation of two doses of human tissue-type plasminogen activator in patients with acute and subacute peripheral arterial occlusion were compared. Seven patients with lower extremity ischemia and one patient with upper extremity ischemia had peripheral arterial thromboses (five arteries, three grafts) confirmed by clinical history, physical examination, and angiography. The duration of occlusion ranged from 31 hours to 30 days (mean 11.9 days). Tissue-type plasminogen activator was infused via a catheter directly into the thrombus at a randomly assigned dose of 0.05 mg/kg/hr (n = 4) or 0.025 mg/kg/hr (n = 4). Thrombolysis was complete in seven patients and partial in one. Duration of infusion ranged from 1 hour to 21 hours (mean 7.4 hours). The low dose required a longer infusion than did the high dose, but they were both successful in achieving thrombolysis. The one patient with partial thrombolysis had abrupt discontinuation of infusion when extravasation through a recently endarterectomized femoral artery developed. Otherwise there were no significant complications from tissue-type plasminogen activator therapy. Secondary procedures to correct underlying arterial disease were performed in five of the seven patients (71%) who had complete thrombolysis. Even at low dosages, infusion of tissue-type plasminogen activator into arteries or bypass graft thrombus produced complete thrombolysis, and no major complications occurred. This allowed more systematic effects to diagnose and treat underlying arterial disease.

Efficacy and tolerance of recombinant tissue-type plasminogen activator in patients with thrombotic or embolic occlusions of leg-arteries

“…Data reported from other studies and case reports suggest that rt-PA may also be useful in the treatment of other thromboembolic diseases [2][3][4][5][6]9]. We evaluated the efficacy and safety of a maximum dose of up to 18 mg rt-PA in 47 patients with thromboembolic occlusions of leg arteries in this open phase II study, from which 44 could be completely evaluated.…”

Lesion-directed administration of alteplase with intracoronary heparin in patients with unstable angina and coronary thrombus undergoing angioplasty

“…Subsequent angioplasty was successful in 94% of patients. Similarly, successful thrombolysis has been reported by local alteplase infusions in peripheral arterial thrombosis [30]. However, in treating seven patients with unstable angina and complex lesions with a higher dose of intracoronary alteplase (50 mg) over 50 min, DiSciascio et al [12] found worsening of the lesion in three patients.…”

Catheter-directed Thrombolytic Therapy for Limb Ischemia: Current Status and Controversies

“…Continuous-infusion protocols have used non-weight-based (42,45,57,58) and weight-based regimens (15,56,64). The non-weight-based doses ranged from 0.5 mg/h to 2 mg/h, with a mean total dose of 19 -42 mg (estimated) over a 19.7-25.1-hour mean duration of infusion (42,45,58).…”

“…The non-weight-based doses ranged from 0.5 mg/h to 2 mg/h, with a mean total dose of 19 -42 mg (estimated) over a 19.7-25.1-hour mean duration of infusion (42,45,58). Several studies have used a weight-based continuous-infusion protocol, with doses ranging from 0.02 mg/kg/h to as high as 0.1 mg/kg/h (15,56,64). Similar to UK, the results of a prospective study of 210 patients with PAOD by Decrinis et al (57) demonstrated greater efficacy in treating patients with embolic occlusions compared with thrombotic occlusions (88% vs 59%).…”