Continuous tenecteplase infusion combined with peri/postprocedural platelet glycoprotein IIb/IIIa inhibition in peripheral arterial thrombolysis: initial safety and feasibility experience.
OBJECTIVE
To evaluate a continuous-infusion protocol for peripheral arterial thrombolysis using tenecteplase (TNK), with regard to the technique, dosing, infusion times, and clinical outcomes.


METHODS
Between November 1999 and July 2002, 48 patients (30 men; mean age 68.5+/-11.9 years) presented with acute limb ischemia (ALI) owing to iliofemoral arterial thrombosis, which was treated with continuous TNK infusion (either 0.50 mg/h [n=22, group A] or 0.25 mg/h [n=26, group B]). All patients received periprocedural heparin (500 U/h) and peri and postprocedural tirofiban for 6 to 12 hours. Follow-up included ankle-brachial index and duplex ultrasound at baseline, 1 month, and 6 months. The variables retrospectively analyzed included total infusion time, total TNK dose, fibrinogen analysis, clinical and thrombolysis outcomes, and complications.


RESULTS
The overall clinical procedural success was 95.8%. Complete (>95%) lysis was observed in 35 (73%) patients; overall mean infusion time was 7.5 hours, and overall mean TNK dose was 4.8 mg. No deaths, intracranial bleeding, or embolic events occurred in either group. Of the 8 (16.7%) complications, 5 (10.4%) were major: 1 femoral repair (group A), 2 >5-cm nonsurgical hematomas (1 in each group), and 2 gastrointestinal hemorrhages (1 in each group). The 3 (6.3%) minor complications were minor hematomas (2 in group A and 1 in group B). The 30-day and 14-month mean limb salvage rates were 95.8% (46/ 48) and 89.6% (43/48), respectively.


CONCLUSIONS
Continuous TNK infusion (0.25-0.50 mg/h) is a safe and feasible treatment for continuous pharmacological thrombolysis in ALI, potentially offering decreased infusion times and bleeding complications, as well as improved outcomes.
Allie
David E
DE
Cardiovascular Institute of the South, Southwest Medical Center, Lafayette, Louisiana 70506, USA. david.allie@cardio.com
Hebert
Chris J
CJ
Lirtzman
Mitchell D
MD
Wyatt
Charles H
CH
Keller
V Antoine
VA
Khan
Mohamed H
MH
Khan
Muhammad A
MA
Fail
Peter S
PS
Stagg
Samuel J
SJ
Chaisson
Gary A
GA
Vitrella
Dennis A
DA
Allie
Sonja D
SD
Allie
Adam A
AA
Mitran
Elena V
EV
Walker
Craig M
CM
D000368:Aged; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007511:Ischemia / Q000188:drug therapy* / Q000209:etiology; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012189:Retrospective Studies; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000379:methods*; D013927:Thrombosis / Q000150:complications / Q000188:drug therapy; D000077466:Tirofiban; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
D005343:Fibrinolytic Agents; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D010959:Tissue Plasminogen Activator; D000077466:Tirofiban; D000077785:Tenecteplase