Intraoperative thrombolytic therapy as a treatment of small vessel thrombosis: an experimental study.
OBJECTIVE
This paper studies the effect of three doses of Streptokinase infused intra-operatively into an animal model of small vessel thrombosis.


METHODS
This is a controlled trial of intraoperative infusion of thrombolytic agent into a thrombosed arterial segment compared to no infusion into the contralateral limb.


METHODS
19 New Zealand White rabbits were stratified into 3 groups.


METHODS
Thrombosis was achieved by infusing a mixture of topical thrombin and autologous blood into individual iliac arteries of the New Zealand white rabbit. A randomly selected hind limb had an infusion of one of three doses of streptokinase (A = 2,500u; B = 5,000u; C = 10,000u) in saline over 20 minute period. Preinfusion and post infusion angiography was performed.


METHODS
Angiograms were ranked by a radiologist blinded to the side of infusion and clotting parameters were assessed.


RESULTS
All limbs at all doses of streptokinase infusion (SK) showed significant clot lysis when compared to the non-infused limb(C). The percentage of improved segments is as follows: iliac: SK = 100%, C = 79%; femoral SK = 79%, C = 32%; tibial SK = 52%, C = 5%. Although there was an elevation in clotting time and a reduction in fibrinogen, levels remained within normal limits.


CONCLUSIONS
Streptokinase infused directly into thrombus in arteries even in low doses significantly enhances thrombolysis of vessels which are too small to be cleared by mechanical means. No significant systemic complications were encountered.
Harris
K A
KA
Department of Surgery, University of Western Ontario, London.
Carroll
S E
SE
Derose
G
G
Jamieson
W G
WG
Kozak
R
R
Meads
G E
GE
Sweeney
J P
JP
D000818:Animals; D005263:Femoral Artery; D006614:Hindlimb; D007083:Iliac Artery; D007261:Infusions, Intra-Arterial; D007430:Intraoperative Care / Q000379:methods; D011817:Rabbits; D011859:Radiography; D013300:Streptokinase / Q000008:administration & dosage*; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D016909:Tibial Arteries
D013300:Streptokinase