Thrombolytische Therapie der tiefen Beinvenenthrombose mit Urokinase

Abstract

In 81 patients with deep vein thrombosis of the lower limb, urokinase therapy was performed in combination with heparin according to a new regimen at higher dosages. When urokinase was administered at an initial maintenance dosage of 1,000-2,000 IU/kg/h (loading dose 150,000-250,000 IU), phlebographically documented complete or partial recanalization could be observed in 68% of the cases. The higher dosage schedule induced a more pronounced deobliteration especially in treatment of iliac vein thromboses (67% recanalization) in comparison to the lower dosage regimen (only 43% recanalization). Nearly comparable therapeutic results could be achieved in therapy of popliteal or saphenous vein thromboses. The data suggest that the higher dosage schedule examined here is indicated in treatment of extensive and large volume thromboses. The dosage of urokinase was further adjusted to attain a reduction of fibrinogen to 50-100 mg/dl. The concentration should not fall below 50 mg/dl. Therapy with urokinase proved practicable. Serious side effects did not occur. 8.6% of the patients showed hematuria and 6% a decrease of the Hb by more than 2 g/dl. The high proportion of older thromboses and the only low rate of recanalization (23%) in these cases suggest the necessity of an early commencement of fibrinolyses in therapy of deep vein thrombosis.

Fibrinolytic Therapy of Deep Vein Thrombosis with Continuous Intravenous Infusion of a Recombinant Tissue Plasminogen Activator

“…These were 19 patients with deep vein thromboses of the lower extremity and three patients with subclavian vein thromboses. Patients with the generally accepted contraindications for fibrinolytic therapy 4 were excluded from treatment with rt-PA. These were hemorrhagic diatheses, acute gastrointestinal ulcers, acute inflammatory diseases of the gastrointestinal tract, surgical procedures carried out less than 2 weeks ago, intrathoracic operations, including cardiac operations within the last 2 weeks, resuscitations less than 4 weeks previously, inflammatory diseases of the heart, atrial fibrillation with enlarged left atrium, arterial hypertension (with values in excess of 200/100 mmHG or with severe stage III/IV fundus lesions), acute pancreatitis, severe cerebral sclerosis, cerebral infarction, intracranial surgical operations, malignant diseases, systemic hematologic disorders not in remission, pregnancy, childbirth less than 5 days previously, liver cirrhosis, esophageal varices, acute pulmonary tuberculosis, and a severe impairment of kidney function.…”

“…Thrombolytic therapy with streptokinase 1,2 and urokinase 3,4 and thrombectomy 5,6 has proved effective in the treatment of deep vein thrombosis of the lower extremities. Long-term investigations indicate that there may be a reduced incidence of late sequelae after treatment with streptokinase.…”

“…[11][12][13] In these cases urokinase can be given alternatively. 3,4 The fibrinolytic substances streptokinase and urokinase induce a nonspecific activation of the fibrinolytic enzyme system. Beside lysis of fibrin, there is destruction of circulating fibrinogen and the blood clotting Factors V, VIII, and XIII.…”

“…Beside lysis of fibrin, there is destruction of circulating fibrinogen and the blood clotting Factors V, VIII, and XIII. 3,4,[14][15][16] Hemorrhagic complications 3,4,[11][12][13]17 that are observed with the use of these thrombolytics are at least partially attributable to the lowering of fibrinogen and plasma clotting factors. The use of fibrin-specific substances might reduce the rate of bleeding with a possible enhancement of the thrombolytic effect.…”

Sustained improvement of pulmonary hemodynamics in patients at rest and during exercise after thrombolytic treatment of massive pulmonary embolism.

“…WHEREAS the short-term effects of thrombolytic treatment in patients with pulmonary embolism (PE) are well known, 14 only a few long-term hemodynamic studies have been conducted.5' 6 Cases of chronic cor pulmonale resulting from unresolved PE have been reported, but the incidence of chronic pulmonary hypertension is not completely known." The factors that determine whether a patient will have complete resolution of a clot or whether unresolved emboli will persist have not been clearly delineated.…”