[Efficacy and safety of the thrombolytic therapy with urokinase after systemic-pulmonary shunt].
OBJECTIVE
To evaluate the efficacy and safety of thrombolytic therapy with urokinase after systemic-pulmonary shunt.


METHODS
Six patients who had thrombosis after systemic-pulmonary shunt were enrolled in this study. At the background of administration of the heparin at a dose of 0.2-0.3 U x kg(-1) min(-1), urokinase was intravenously administered with a loading dose of 15-20 U x kg(-1) x min(-1) and a locked time period of 30 minutes, and then the dose was incessantly decreased to 4-10 U x kg(-1) x min(-1). In addition to echocardiography (ECG), arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2), fibrinogen, activated partial thromboplastin time, and prothrombin time were determined to assess the clinical efficacy and side effects.


RESULTS
The thrombolytic therapy with urokinase showed clinical effectiveness within 1 or 2 hours in all 6 patients. Efficiency of this therapy reached 100% during 12 to 24 hours. In 5 patients, the PaO2/FiO2 were over 50% higher than the early postoperative values. One patient received a second operation due to the excessively increased pulmonary blood flow. In 2 patients, pleural and mediastinal drainages increased when the thrombolytic therapy with urokinase began; however, they decreased after the urokinase dosages were adjusted.


CONCLUSIONS
It is feasible to use the thrombolytic therapy with proper dosage of urokinase after systemic-pulmonary shunt.
Zhang
Bao-Hua
BH
Intensive Care Unit, Department of Cardiovascular Surgery, Xi'an Gaoxin Hospital, Xi'an 710075, China. zhanbahu@yahoo.com.cn
Tang
Wei
W
Yang
Guang
G
Zhao
Yu-Hong
YH
D001011:Aorta / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D008297:Male; D011170:Portasystemic Shunt, Surgical; D011183:Postoperative Complications / Q000188:drug therapy; D011651:Pulmonary Artery / Q000601:surgery; D011655:Pulmonary Embolism / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator