Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis.
OBJECTIVE
To compare the efficacy, safety, and costs associated with catheter-directed thrombolysis with urokinase (UK) and the recombinant agents alteplase (tissue plasminogen activator [TPA]) and reteplase (recombinant plasminogen activator [RPA]) in the treatment of symptomatic deep vein thrombosis (DVT).


METHODS
The authors conducted a retrospective analysis on 74 patients (82 limbs) who underwent treatment for DVT. Thrombosed extremities were treated with either urokinase with therapeutic heparin dosing (UK group; 38 limbs), alteplase with subtherapeutic heparin dosing (TPA group; 32 limbs), or reteplase with subtherapeutic heparin dosing (RPA group; 12 limbs). Infusion times, dosages, drug costs, success rates, and complications were compared among the groups.


RESULTS
Gender, age, disease location, duration of symptoms, and use of additional interventional therapies did not differ statistically among the three cohorts. Median hourly infused doses, total doses, infusion times, drug costs, and success rates per limb were: UK, 11.3 (10(4)) U/hour, 4.361 million U, 40.6 hours, US dollars 6577, 97.4%; TPA, 0.57 mg/hour, 21.6 mg, 30.8 hours, US dollars 488, 96.9%; RPA, 0.74 U/hour, 21.4 U, 24.3 hours, US dollars 1787, 100.0%. Major and overall complication rates were: UK, 5.3% and 10.5%; TPA, 3.1% and 12.5%; RPA, 8.3% and 16.7%. Infusion times, success rates, and complications were not statistically different among the three groups. Alteplase and reteplase were significantly less expensive than urokinase (P <.001 and P <.01, respectively).


CONCLUSIONS
Catheter-directed thrombolysis for the treatment of DVT is safe and effective, regardless of the agent used. However, the new recombinant agents are significantly less expensive than urokinase.
Grunwald
Michael R
MR
The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Blalock 545, 600 N Wolfe Street, Baltimore, Maryland 21287, USA.
Hofmann
Lawrence V
LV
D000328:Adult; D003365:Costs and Cost Analysis / Q000191:economics; D005121:Extremities / Q000098:blood supply* / Q000473:pathology*; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use*; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000191:economics / Q000627:therapeutic use*; D011994:Recombinant Proteins / Q000191:economics / Q000627:therapeutic use*; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000191:economics; D010959:Tissue Plasminogen Activator / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000191:economics / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000191:economics
D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; C087896:reteplase; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator