Reteplase infusion in the treatment of acute lower extremity occlusions.
OBJECTIVE
Reteplase, a recombinant tissue plasminogen activator, has been used in the treatment of acute coronary occlusion. Experience is accumulating regarding its use in the treatment of peripheral vascular disease. Increased experience with this thrombolytic agent may show that it can be an appropriate alternative agent to currently employed plasminogen activators.


METHODS
Over the course of six months, reteplase was used to treat 18 patients with peripheral arterial occlusions, confined to the lower extremities. The agent was infused via "pulse-spray" catheters. Fifteen patients were started on 0.5 U/h. Concurrent heparin therapy was used at 500 U/h in 16 of 18 patients.


RESULTS
The average total dose of reteplase infused was 13.3 units. It ranged from 6.2 to 41.5 units. The average duration of infusion was 26.9 hours with a range of 12-44 hours. Clinical success, defined as restoration of sufficient patency to reestablish limb function and resolution of pain in the symptomatic extremity was 89% (16 out of 18). Hemorrhagic complications occurred in five patients and were major in one patient (5%). No patient experienced intracranial hemorrhage.


CONCLUSIONS
Increased experience with the use of reteplase in the treatment of acute lower extremity occlusions is accumulating. The safety and efficacy profile in our group appears satisfactory and compares to other studies. However, definite conclusions must await the results of controlled comparisons of different reteplase infusion regimens and controlled comparison to other thrombolytic agents.
Kiproff
Paul M
PM
Division of Vascular and Interventional Radiology, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA. pkiproff@upahs.org
Yammine
Kabalan
K
Potts
Jonathan M S
JM
Nahum
Elmer
E
D001157:Arterial Occlusive Diseases / Q000150:complications / Q000188:drug therapy*; D002404:Catheterization; D004341:Drug Evaluation; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000633:toxicity; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D010146:Pain; D011994:Recombinant Proteins / Q000008:administration & dosage* / Q000633:toxicity; D012189:Retrospective Studies; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000633:toxicity; D016896:Treatment Outcome; D014654:Vascular Patency / Q000187:drug effects
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010959:Tissue Plasminogen Activator