Tenecteplase in Acute Lower-leg Ischemia: Efficacy, Dose, and Adverse Events

Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia

“…124 Three other studies found no association between a drop in or low level of plasma fibrinogen and haemorrhagic complications. 118,125,126 Although there is some evidence that very low levels of plasma fibrinogen (< 1.0 or < 1.5 g/L) are indicators of bleeding risk, a systematic review concluded the predictive value of plasma fibrinogen for bleeding during thrombolysis is unproven, so regular monitoring is not recommended. 127 3.5.6.…”

Catheter-Directed Thrombolysis for Acute Limb Ischemia

“…The few reports on TNK use in limb ischemia, all retrospective case series, suggest that using TNK may indeed result in a lower rate of bleeding complications with equivalent efficacy compared with historical data. 31 There are, however, no reported controlled studies comparing TNK with either rtPA or rPA for peripheral arterial CDT, and thus the level of evidence is low.…”

“…The frequency of bleeding complications was either equivalent or higher. 29,31,[36][37][38][39] Experience with tirofiban and eptifibatide is more limited. 40 Use of these agents in peripheral arterial CDT has not been widely adopted given the results so far.…”

Fibrinogen Level and Bleeding Risk During Catheter-Directed Thrombolysis Using Tissue Plasminogen Activator

“…[9][10][11] There is no consistent evidence to support the notion that low fibrinogen levels during thrombolysis increase bleeding risk. 4,5,12,13 Although evidence for predicting bleeding risk is limited, fibrinogen level is measured frequently during CDT to allow for adjustment of the infusion rate of thrombolysis. A recent survey conducted during the 2014 Canadian Society of Vascular Surgery's annual meeting showed that over 75% of attendees monitor fibrinogen level during CDT (Canadian Society for Vascular Surgery Annual Meeting 2014.…”