Safety and efficacy of limited-dose tissue plasminogen activator in acute vascular occlusion

Abstract

Limited-dose t-PA is a safe and effective therapy for AAO and AVO when administered by experienced teams using innovative but well-established interventional techniques.

The Association of Periprocedural Hypertension and Adverse Outcomes in Patients Undergoing Catheter-Directed Thrombolysis

“…The incidence of major hemorrhage in previous studies ranged from 0-32%, 1,3,9,[15][16][17] and were found to be associated with age, dose, and various comorbidities. Our major hemorrhage rate (10.4%) was higher than in most reported series, with a history of congestive heart failure and periprocedural blood pressure of >180 mmHg systolic being the significant comorbidity of this event.…”

“…When combining thrombotic and embolic occlusions treated with thrombolytic agents, the success rate ranges from 60-90%. [1][2][3] The treatment goals in lower extremity DVT are to prevent the embolic potential of existing thrombus burden, restore unobstructed flow, prevent recurrence, and preserve venous valve function. Traditionally, the treatment for DVT has been systemic anticoagulation; however, previous studies have shown catheter-directed thrombolysis to have superior results with success rates of over 90%, 4,5 with 79% of completely lysed vessels remaining patent at 1 year.…”

Diagnosis and Treatment of Lower Extremity Deep Vein Thrombosis: Korean Practice Guidelines

“…In a multicenter registry, the major bleeding complication rate was up to 11.4%, whereas studies thereafter using recombinant tissue plasminogen activator (TPA) reported major bleeding rates of 2%-4% [153,[157][158][159][160]. The lower major bleeding rates in the later studies may reflect the different drug regimen, US-guided puncture of the access vein, different patient selection criteria, or a combination of these factors.…”

Endovascular Interventions for Acute and Chronic Lower Extremity Deep Venous Disease: State of the Art

“…Symptomatic pulmonary embolism and fatal pulmonary embolism occurred in 1.3% and 0.2% of patients, respectively. In more recent experiences using infusions of recombinant tissue plasminogen activator at low doses (0.5-1.0 mg/h), major bleeding has occurred in only 2%-4% of patients (48)(49)(50). Reasons for this apparent difference may be improved patient selection, use of "subtherapeutic" heparin dosing during thrombolysis, and the routine use of US-guided venipuncture, which has limited access site bleeding due to inadvertent arterial puncture.…”