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Tissue plasminogen activator in peripheral arterial thrombolysis.
D C Berridge1, R H Gregson, G S Makin
1Department of Vascular Surgery, University Hospital, Nottingham, UK.
The British Journal of Surgery
|February 1, 1990
Summary
Low-dose intra-arterial recombinant tissue plasminogen activator (t-PA) effectively treated acute peripheral arterial thromboses, achieving 83% limb salvage. Adding heparin showed no significant benefit, indicating t-PA
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Cardiovascular Medicine
Background:
- Acute peripheral arterial thrombosis poses a significant risk of limb loss.
- Intra-arterial thrombolysis is a potential treatment strategy for acute limb ischemia.
Purpose of the Study:
- To evaluate the safety and efficacy of low-dose intra-arterial recombinant tissue plasminogen activator (t-PA) for acute peripheral arterial thromboses.
- To assess the added benefit of intra-arterial heparin in conjunction with t-PA.
Main Methods:
- Thirty acute peripheral arterial thromboses in 28 patients were treated with local low-dose intra-arterial t-PA (0.5 mg/h).
- Fifteen patients also received intra-arterial heparin (250 units/h).
- Outcomes including limb salvage, ankle-brachial index, and complications were assessed at 30 days.
Main Results:
- Overall limb salvage at 30 days was 83% (25/30 limbs).
- Mean ankle-brachial index increased by 0.53(0.26) without significant difference between groups.
- Minor hematomas occurred in 13% of patients; no strokes or major hemorrhages were reported. Four deaths (13%) occurred due to myocardial infarction.
Conclusions:
- Low-dose intra-arterial t-PA is a safe and effective thrombolytic agent for acute peripheral arterial thromboses.
- The addition of low-dose intra-arterial heparin does not provide significant additional benefit.
- Further research may explore optimal anticoagulation strategies in conjunction with thrombolysis.