Peripheral artery and bypass graft thrombolysis with recombinant human tissue-type plasminogen activator.
Recombinant tissue-type plasminogen activator (t-PA) is a DNA-synthesized thrombolytic agent recently approved for clinical trials. We present the results of t-PA infusions in 18 patients with thrombosed peripheral arteries (12 patients) and peripheral bypass grafts (six patients). The duration of occlusion ranged from 1 to 21 days (mean, 6.8 days). Infusions of t-PA were done by way of an intra-arterial approach at a dose of 0.1 mg/kg/hr. All patients demonstrated thrombus lysis angiographically. Fifteen of 18 (83%) had clinical as well as angiographic improvement. Secondary procedures to maintain patency of the arterial segment were required in seven patients. No complications occurred that were related to the t-PA infusion. No significant prolongation of the prothrombin, thrombin, or activated partial thromboplastin times occurred. At the end of t-PA infusion, the mean circulating fibrinogen level was 59% of the starting value. The therapeutic use of t-PA is still in its preliminary stages and the efficacy and safety of this promising agent need to be further established. From our early experience with t-PA, it appears to be safe as well as effective.
Graor
R A
RA
Risius
B
B
Young
J R
JR
Denny
K
K
Beven
E G
EG
Geisinger
M A
MA
Hertzer
N R
NR
Krajewski
L P
LP
Lucas
F V
FV
O'Hara
P J
PJ
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000627:therapeutic use*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator