The lowest effective dose of tissue plasminogen activator for fibrinolysis of postvitrectomy fibrin.
Tissue plasminogen activator (tPA) has been shown to be effective at a dose of 25 micrograms in the treatment of severe postvitrectomy fibrin. However, a recent report based on an animal model indicates that retinal toxicity may occur at doses as low as 25 micrograms. This study uses a low dose (1.5 micrograms to 3 micrograms) of tPA for 34 injections in 26 eyes, and determines the lowest effective dose to be between 1.5 and 3 micrograms. Complete fibrinolysis was achieved in all 28 eyes in which 3 micrograms of tPA was administered within 10 days of vitrectomy, whereas partial fibrinolysis was achieved in eyes treated with 3 micrograms of tPA 27 days and 82 days after vitrectomy. Complete fibrinolysis occurred in only 1 of 4 eyes that receive 1.5 micrograms of tPA. A dose of 3 micrograms of tPA is recommended for treatment of severe fibrin after vitrectomy, as it has a wider margin of safety than do higher doses.
Boldt
H C
HC
Department of Ophthalmology, Medical College of Wisconsin, Milwaukee.
Abrams
G W
GW
Murray
T G
TG
Han
D P
DP
Mieler
W F
WF
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000378:metabolism; D011994:Recombinant Proteins / Q000008:administration & dosage; D012163:Retinal Detachment / Q000378:metabolism / Q000601:surgery; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014821:Vitrectomy / Q000009:adverse effects*
D011994:Recombinant Proteins; D005337:Fibrin; D010959:Tissue Plasminogen Activator