Peripheral thrombolysis with tissue plasminogen activator. Results of two treatment regimens.
OBJECTIVE
The purpose of this study was to document the response to tissue plasminogen activator given as either a low-dose intra-arterial infusion or a bolus infusion in patients with peripheral arterial or bypass graft occlusion.


METHODS
Fifty thrombolytic procedures were carried out in 45 patients with a recent occlusion of a peripheral artery (41) or bypass graft (nine). A continuous infusion of 1.0 mg/h of tissue plasminogen activator was used in 27 patients (group A), while 23 patients were given a 20-mg bolus followed by an infusion of 1.0 mg/h (group B). Patients in the two groups were followed up for 12.1 +/- 9.3 months and 11.1 +/- 9.1 months, respectively.


RESULTS
In group A, the angiographic lysis rate was 74% and clinical success rate was 67%. In group B, the comparable rates were 70% and 48%. Lysis was quicker when a bolus infusion was used, the mean lysis time being 14.4 +/- 7.9 hours compared with 26.7 +/- 9.4 hours following infusion alone (P = .0005). There was one instance of major hemorrhage in group A and eight in group B (P = .0022), including two patients with cerebral hemorrhage, one of whom died.


CONCLUSIONS
Low-dose tissue plasminogen activator infusion is safe and reasonably effective, although a long treatment time is required. A bolus infusion regimen speeds lysis but is attended by a high incidence of serious hemorrhage.
Ward
A S
AS
Department of Surgery, District Hospital, Basingstoke, England.
Andaz
S K
SK
Bygrave
S
S
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D010959:Tissue Plasminogen Activator