Thrombolysis of acute peripheral arterial and venous occlusions with tenecteplase and eptifibatide: a pilot study.
OBJECTIVE
To prospectively assess the feasibility, risk profile, and effect on fibrinogen levels of combination tenecteplase (TNK) and eptifibatide in transcatheter thrombolysis for peripheral arterial and venous thromboocclusive disease.


METHODS
Sixteen consecutive patients (seven men, nine women) seen at our institution between March and August 2002 with arterial (n = 11) or venous (n = 5) thromboocclusive disease were treated with TNK (5-mg bolus and 0.25-mg/h infusion) and eptifibatide (180- micro g/kg bolus and 1- micro g/kg/min infusion). Informed consent was obtained. Technical success was defined as restoration of antegrade flow and more than 95% removal of thrombus. Clinical success in arterial cases was defined as immediate limb salvage and relief of ischemic rest pain, and in venous cases as resolution or improvement in extremity pain and swelling. Major bleeding was defined as an intracranial bleeding episode, bleeding resulting in death, or bleeding requiring transfusion, surgery, or cessation of thrombolytic therapy.


RESULTS
Technical success was achieved in 10 of 11 arterial cases (91%) and in four of five venous cases (80%). Clinical success was achieved in nine of 11 arterial cases (82%) and in four of five venous cases (80%). The mean duration of thrombolysis was 12.1 hours +/- 5.8 (range, 2-22 hours), requiring a total TNK dose of 8.0 mg +/- 1.5 (range, 4.0-10.5). A major bleeding episode occurred in one of 16 patients (6.3%) as a result of slow oozing from a femoral groin access site and required transfusion of 2 U of packed red blood cells. There were no deaths, intracranial hemorrhages, remote sites of bleeding, or minor bleeding complications. The serum fibrinogen level decreased to a mean of 59.3% +/- 34.6 of baseline.


CONCLUSIONS
In this initial study, the combination of TNK and eptifibatide was shown to be feasible for peripheral arterial and venous thrombolysis.
Burkart
David J
DJ
Alliance Radiology, Division of Interventional Radiology, Saint Joseph Health Center, 1000 Carondelet Drive, Kansas City, Missouri 64114, USA. dburkart@kc.rr.com
Borsa
John J
JJ
Anthony
James P
JP
Thurlo
Stephanie R
SR
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000188:drug therapy* / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D005260:Female; D005263:Femoral Artery / Q000187:drug effects / Q000473:pathology; D005268:Femoral Vein / Q000187:drug effects / Q000473:pathology; D005340:Fibrinogen / Q000187:drug effects / Q000378:metabolism; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006400:Hematocrit; D006454:Hemoglobins / Q000187:drug effects / Q000378:metabolism; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006801:Humans; D007083:Iliac Artery / Q000187:drug effects / Q000473:pathology; D007084:Iliac Vein / Q000187:drug effects / Q000473:pathology; D035002:Lower Extremity / Q000098:blood supply* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008923:Missouri; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use*; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000401:mortality; D010865:Pilot Projects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011150:Popliteal Artery / Q000187:drug effects / Q000473:pathology; D011152:Popliteal Vein / Q000187:drug effects / Q000473:pathology; D011446:Prospective Studies; D000077785:Tenecteplase; D015912:Thrombolytic Therapy; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000187:drug effects / Q000473:pathology; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000401:mortality
D015415:Biomarkers; D005343:Fibrinolytic Agents; D006454:Hemoglobins; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator; D000077542:Eptifibatide; D000077785:Tenecteplase