Reteplase with or without abciximab for peripheral arterial occlusions: efficacy and adverse events

To retrospectively evaluate reteplase in thrombolysis of peripheral arterial occlusion (PAO).

Forty limbs in 36 patients were treated with reteplase (0.5 U/h) with or without abciximab (bolus and 12-hour infusion). Twenty-four occlusions were in bypass grafts and 16 were in native arteries. Nineteen patients were treated with reteplase alone and 21 patients were treated with reteplase and abciximab. Chart review provided data from procedures and follow-up at 30 days and 6 months. Multivariable, analysis of variance, and Student t test comparisons of results and complications were performed.

Reteplase infusions averaged 31 hours in duration (range, 12-72 hours). The technical success rate was 80%. The clinical success rates were: immediate, 80%; 30-day, 65%; and 6-month, 45%. Major bleeding complications occurred in 20% of cases and intracranial hemorrhage occurred in 2.5%. The 6-month amputation-free survival rate was 78%. Major, minor, and lack of complications were statistically associated with mean decreases in fibrinogen levels from baseline of 72%, 46%, and 15%, respectively (P =.000013). Complications were not associated with length of infusion or use of abciximab (P =.77). Patients with grafts accounted for 89% of the major complications (eight of nine; P =.009) and had worse clinical success immediately (71%), at 30 days (50%), and at 6 months (21%; P =.002, P =.003, P =.00001).

There was significant fibrinogen depletion with use of reteplase for PAO. The percent decrease in fibrinogen level correlates with lack of complications and incidence of minor and major complications. Abciximab use did not increase the complication rate. Thrombolysis of grafts is associated with increased incidence of complications and worse outcomes compared with thrombolysis of native arteries.