K. Kroger et al., Retrospective analysis of rt-pa thrombolysis combined with PGE(1) in patients with peripheral arterial occlusions, ANGIOLOGY, 51(5), 2000, pp. 377-384
Although thrombolysis has been established for recanalization of acute and
in part chronic peripheral artery occlusions, only smaller studies exist re
garding the use of longterm rt-pa infiltration-thrombolysis. The objective
of this study was to evaluate the benefit of additional long-term thromboly
sis in patients with peripheral arterial occlusions for whom acute thrombol
ysis failed. From 1992 to 1997, 323 patients with peripheral arterial occlu
sions were treated with rt-pa (recombinant tissue-type plasminogen activato
r). When the thrombolysis failed during the first 3 hours, the thrombolytic
therapy was continued as a long-term treatment with 3 mg rt-pa alternated
by PGE, (2.1 mL/hr for 3 hours, concentration: 20 mu g/50 mL NaCl) every 3
hours. Additional heparin was applied in doses of 15,000 IE/24 hr or more t
o slightly increase the partial thromboplastin time. Angiographic controls
were performed every 24 hours. If necessary, a final angioplasty was perfor
med. In 142 of the 323 patients the occlusions were recanalized during the
first 3 hours; 119 patients were treated with a long-term thrombolysis and
in 72 (61%) a recanalization was ultimately achieved. Thus, the recanalizat
ion rate increased to 214 of 323 patients (p < 0.02). Mean treatment time w
as 2.8 +/- 2.2 days, range: 1 to 13 days. The rates of recanalization were
not different in iliac, femoral, or crural arteries. Fibrinogen levels did
not decrease during thrombolysis. Severe bleeding (with a decrease of more
than 3 g/dL hemoglobin requiring transfusion) occurred in four patients aft
er finishing the thrombolysis with short-term and in six with long-term the
rapy; two required surgical treatment. The 1-, 2-, and 3-year cumulative pa
tency rates were respectively 90.1%, 74.2% and 64.9%. Patency rates in pati
ents with acute or long-term thrombolysis were not different. A composite t
hrombolytic treatment using low-dose rt-pa in combination with PGE(1) offer
s significantly better results than an acute thrombolytic treatment alone.
It can be an effective and practicable regimen in about 60% of patients in
whom acute thrombolysis fails.