title: Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis.
abstract: OBJECTIVE
  Catheter-directed thrombolytic dissolution of peripheral arterial and venous thrombus is in widespread use, yet the frequency and nature of associated complications remain ill defined. In an effort to better characterize the complications associated with urokinase (UK) and recombinant tissue plasminogen activator (rt-PA), the clinical course of patients treated for lower extremity vascular occlusions at a single institution was reviewed.
  
  
  METHODS
  Over a 9-year period, 653 consecutive patients were treated for lower extremity arterial (527 patients) or venous (126 patients) occlusions with catheter-directed UK (483 patients), rt-PA (144 patients), or both (26 patients). Decisions regarding the choice of thrombolytic agent were made by the clinician. In-hospital complications were subcategorized into hemorrhagic and nonhemorrhagic events and the rate of intracranial hemorrhage was specifically tabulated.
  
  
  RESULTS
  There were no significant differences in the demographics or clinical presentation of patients treated with either UK or rt-PA. Bleeding complications occurred less often in the patients treated with UK (insertion site hematoma 21.9% vs. 43.8%, P<.0001, any bleeding necessitating transfusion 12.4% vs. 22.2%, P = .004, and intracranial hemorrhage 0.6% vs. 2.8%, P = .031). Cardiopulmonary complications necessitating transfer to the intensive care unit occurred more frequently in the patients treated with rt-PA (4.9% vs. 1.5%, P = .015). The risk of mortality was not statistically different between the UK and rt-PA treated patients (2.7% vs. 6.2%, P = .221).
  
  
  CONCLUSIONS
  Thrombolysis appears safer with UK than with rt-PA, with a lower incidence of hemorrhagic complications. It is possible that this finding is related to differential dosing regimens or intrinsic pharmacologic differences between the agents. The observations of this retrospective analysis require confirmation with a prospective, randomized evaluation.
authors.affiliation: Department of Vascular Surgery, The Cleveland Clinic Foundation, OH 44195, USA. ourielk@ccf.org
authors.forename: K
authors.initials: K
authors.lastname: Ouriel
authors.forename: B
authors.initials: B
authors.lastname: Gray
authors.forename: D G
authors.initials: DG
authors.lastname: Clair
authors.forename: J
authors.initials: J
authors.lastname: Olin
mesh_terms: D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D002406:Catheterization, Peripheral; D006470:Hemorrhage / Q000139:chemically induced* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007866:Leg / Q000098:blood supply; D009820:Ohio / Q000453:epidemiology; D010960:Plasminogen Activators / Q000009:adverse effects*; D011446:Prospective Studies; D011994:Recombinant Proteins; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*; D014568:Urokinase-Type Plasminogen Activator / Q000009:adverse effects*; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D011994:Recombinant Proteins; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator