Fibrinolytic agents for peripheral arterial occlusion.

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Pharmacology

Background:

• Peripheral arterial thrombolysis is crucial for managing limb ischaemia.
• Safety concerns with streptokinase prompted research into alternative agents like urokinase and recombinant tissue plasminogen activator (rt-PA).
• Newer agents such as pro-urokinase and recombinant staphylokinase are also emerging.

Purpose of the Study:

• To compare the effectiveness of different fibrinolytic agents in treating peripheral arterial ischaemia.
• To evaluate vessel patency, lysis time, limb salvage, and complication rates associated with various thrombolytic therapies.

Main Methods:

• A systematic review of randomized controlled trials (RCTs) was conducted.
• Searches included the Cochrane Peripheral Vascular Diseases Group Specialised Register and the Cochrane Central Register of Controlled Trials (CENTRAL).
• Data on vessel patency, lysis time, limb salvage, amputation, death, and complications were analyzed.

Main Results:

• Intra-arterial rt-PA demonstrated superior vessel patency compared to intra-arterial streptokinase and intravenous rt-PA.
• No significant difference in limb salvage was observed between urokinase and rt-PA.
• Intra-arterial rt-PA was associated with a lower risk of hemorrhagic complications than intravenous rt-PA and intra-arterial streptokinase.

Conclusions:

• Intra-arterial rt-PA may be more effective for improving vessel patency in peripheral arterial occlusion than streptokinase or intravenous rt-PA.
• Evidence does not strongly support rt-PA being more effective than urokinase, though lysis may be faster.
• Limited study sizes and data scarcity prevent definitive conclusions on the comparative efficacy and safety of these fibrinolytic agents.