Efficacy versus Complications in Arterial Thrombolysis

Area of Science:

• Vascular Surgery
• Interventional Cardiology
• Emergency Medicine

Background:

• Acute peripheral arterial occlusions pose significant threats to limb and life.
• Thrombolysis offers a minimally invasive alternative to surgical thromboembolectomy.
• Optimal thrombolysis protocols lack consensus, with current guidelines based on dated research.

Purpose of the Study:

• To evaluate treatment outcomes of thrombolysis for acute limb ischemia in a contemporary patient cohort.
• To identify predictors of successful treatment and potential bleeding complications.
• To assess mortality and amputation-free rates following thrombolysis.

Main Methods:

• Retrospective analysis of electronic health records for patients undergoing thrombolysis for lower extremity arterial occlusions (April 2006 - June 2012).
• Evaluation of clinical improvement, bleeding complications, thrombolysis duration, and mortality/amputation-free rates at 30 days and 6 months.
• Identification of predictors for outcome and complications.

Main Results:

• Clinical improvement was observed in 79% of 109 patients.
• Amputation-free rates were high at 94% (30 days) and 90% (6 months).
• Major bleeding complications occurred in 13%; mortality rates were 7% (30 days) and 16% (6 months), unrelated to bleeding. Age, female sex, and cardiac history predicted bleeding risk.

Conclusions:

• High-dose thrombolysis in an intensive care unit setting achieves high clinical success for peripheral arterial occlusions.
• Major bleeding complications are a significant concern, necessitating strict clinical observation.
• Intensive monitoring of hemostatic parameters during thrombolysis does not reliably predict bleeding complications.