Fibrinolytic agents for peripheral arterial occlusion.

Area of Science:

• Vascular Medicine
• Interventional Cardiology
• Pharmacology

Background:

• Peripheral arterial thrombolysis is crucial for managing peripheral arterial ischemia.
• Safety concerns with streptokinase prompted the use of urokinase and recombinant tissue plasminogen activator (rt-PA).
• Newer agents like pro-urokinase and recombinant staphylokinase are emerging.

Purpose of the Study:

• To compare the effectiveness of different fibrinolytic agents in treating peripheral arterial ischemia.
• To update previous reviews on fibrinolytic agents for peripheral arterial occlusion.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) identified through the Cochrane Peripheral Vascular Diseases Group.
• Searched specialized registers and CENTRAL up to March 2013.
• Analyzed outcomes including vessel patency, time to lysis, limb salvage, amputation, death, and complications like hemorrhage and stroke.

Main Results:

• Intra-arterial rt-PA showed greater vessel patency than intra-arterial streptokinase or intravenous rt-PA in one study.
• No significant difference in limb salvage at 30 days between urokinase and rt-PA.
• Bleeding complication rates varied, with no significant difference between intra-arterial urokinase and rt-PA, but higher risks with intravenous rt-PA and intra-arterial streptokinase compared to intra-arterial rt-PA.

Conclusions:

• Intra-arterial rt-PA may be more effective for vessel patency in peripheral arterial occlusion than streptokinase.
• No clear evidence of rt-PA superiority over urokinase for limb salvage or bleeding.
• Findings are limited by small study sizes and a paucity of data, preventing definitive conclusions.