Ultrasound-accelerated thrombolysis in arterial and venous peripheral occlusions: fibrinogen level effects.
OBJECTIVE
This study retrospectively assesses whether significantly accelerating thrombolysis with ultrasound affects fibrinogen levels in the treatment of peripheral arterial occlusions.


METHODS
Between December 2005 and August 2007, 38 limbs in 38 patients (17 women; mean age, 60.5 +/- 19.7 years; age range, 17-94 years) were treated with ultrasound-accelerated thrombolysis for peripheral arterial occlusion (PAO) and deep vein thrombosis (DVT), with serum fibrinogen levels measured at baseline and every 24 hours. All occlusions were treated with alteplase (0.5-1.0 mg/h).


RESULTS
Complete or partial lysis was achieved in 92.1% of patients. All patients received thrombolytic therapy with mean infusion time of 42.3 hours (range, 20-96 hours). As part of standard clinical practice, patients were not assessed angiographically overnight. Mean total alteplase dose was 40.6 mg (range, 18-96 mg). Across all patients, the fibrinogen level at the end of infusion decreased by an average of 18.5% from baseline, and no patient exhibited a fibrinogen level < 100 mg/dL during treatment. Fibrinogen depletion was more pronounced among patients with venous occlusions (26.4% from baseline) than those with arterial occlusions (15.8% from baseline). No major hemorrhagic complications occurred. One patient (2.6%) experienced a minor bleeding event at the access site, and use of thrombolytics was discontinued; and one patient with a chronic arterial occlusion and underlying coronary disease who did not respond to thrombolytic therapy, experienced an acute myocardial infarction. Of documented 30-day clinical outcomes in 20 patients, 80.0% remained patent at 30 days.


CONCLUSIONS
Ultrasound-accelerated thrombolysis for the treatment of PAO and DVT is associated with a very low complication rate and nominal fibrinogen depletion.
Raabe
Rodney D
RD
Department of Radiology, Sacred Heart Medical Center, 101 West Eighth Avenue, PO Box 2555, Spokane, WA 99220-2555, USA. rraabe@inland-imaging.com
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D015536:Down-Regulation; D004334:Drug Administration Schedule; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D011859:Radiography; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D014861:Washington; D055815:Young Adult
D015415:Biomarkers; D005343:Fibrinolytic Agents; D005340:Fibrinogen; D010959:Tissue Plasminogen Activator