Local low dose intra-arterial thrombolytic therapy: the risk of stroke or major haemorrhage

The use of local low dose thrombolysis is gradually increasing. Most experience is with streptokinase, although newer agents such as recombinant tissue plasminogen activator (rTPA) may offer more effective lysis with reduced complications. We have reviewed the experience documented in 19 prospective series published between 1974 and 1988 in an attempt to define the incidence of stroke, major haemorrhage and minor haemorrhage. The overall risk of stroke was 1.0 per cent of patients (14 cases). Major haemorrhage occurred in 5.1 per cent of patients (71 cases) and minor haemorrhage occurred in 14.8 per cent (92 out of 620 cases). There was little difference between the two thrombolytic agents, although the experience with lower doses of rTPA suggests it may offer a reduced risk of haemorrhagic complications. It is essential that all studies concerning thrombolysis should give their exclusion and inclusion criteria in full to allow an accurate appraisal of haemorrhagic complications, with the hope of improved patient selection and reduced morbidity in the future.