Thrombolytic therapy in peripheral arterial occlusive disease: mechanisms of action and drugs available.
Catheter-directed thrombolytic therapy has become an important part of the treatment of patients with acute arterial and graft occlusion. The underlying pharmacologic principle is the activation of plasminogen, bound to fibrin within the thrombus. Guide-wire passage reliably predicts success of catheter-directed thrombolysis. The underlying disease process leading to thrombosis should be accurately identified and promptly corrected to reduce the probability of recurrent occlusion. Streptokinase (SK), urokinase (UK) and recombinant tissue plasminogen activator (rt-PA) are the three agents used to treat peripheral arterial occlusive disease. The evolution from SK to UK and rt-PA and improvements in techniques and delivery systems have led to improved success rates and lower complication rates. Patient selection, basic technical considerations and overall results are discussed here. The currently available thrombolytic agents, as well as those being developed, are reviewed to provide background information for current and future applications.
Comerota
A J
AJ
Department of Surgery, Temple University School of Medicine, Philadelphia, Penn.
Cohen
G S
GS
D000208:Acute Disease; D000792:Angiography; D000818:Animals; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D001779:Blood Coagulation Factors / Q000032:analysis; D002986:Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D016903:Drug Monitoring; D006493:Heparin / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*; D012008:Recurrence; D013300:Streptokinase / Q000494:pharmacology / Q000627:therapeutic use*; D015912:Thrombolytic Therapy / Q000295:instrumentation / Q000379:methods* / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*
D001779:Blood Coagulation Factors; D006493:Heparin; D013300:Streptokinase; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator