title: Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of once-daily intraclot injections of low doses (≤ 10 mg) of tissue plasminogen activator (tPA) for thrombolysis of venous thrombosis.
  
  
  METHODS
  In prospective studies, 33 patients with subclavian, jugular, and central venous thrombosis (SJ-CVT) (all but two cases associated with central catheters) were treated once a day with ≤ 4 mg/day of tPA, and 30 patients with acute deep vein thrombosis of the lower extremity (DVT-LE) < 14 days old were treated once a day with ≤ 10 mg/leg/day of tPA by intraclot "lacing" of thrombus without continuous infusions of tPA.
  
  
  RESULTS
  Patency was restored in 26 (79%) of 33 patients with SJ-CVT using an average total dose of 7.1 mg of tPA/per patient and average of 2.1 treatments or days of therapy. Five patients received thrombolytic therapy for SJ-CVT as outpatients. Initial patency was restored in 29 (97%) of 30 patients with acute DVT-LE using an average total dose of 20 mg of tPA per patient over an average of 2.7 treatments/or days per patient. Follow-up imaging examinations at 6 months showed continued patency in 27 (96%)/of 28 patients. There were no major bleeding complications, and no patient required a blood transfusion.
  
  
  CONCLUSIONS
  Intraclot injection of low doses of alteplase is effective for acute venous thrombosis, and pharmacokinetic data suggest potentially greater safety.
authors.affiliation: Radiology and Imaging Sciences Department, Warren G Magnuson Clinical Center, National Institutes of Health, 9000 Rockville Pike, Building 10, Room 1C-338, Bethesda, MD 20892, USA. rchang@cc.nih.gov
authors.forename: Richard
authors.initials: R
authors.lastname: Chang
authors.forename: McDonald K
authors.initials: MK
authors.lastname: Horne
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Shawker
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kam
authors.forename: Enn Alexandria
authors.initials: EA
authors.lastname: Chen
authors.forename: Galen O
authors.initials: GO
authors.lastname: Joe
authors.forename: Willie L
authors.initials: WL
authors.lastname: Ching
authors.forename: Edie
authors.initials: E
authors.lastname: Mao
authors.forename: David A
authors.initials: DA
authors.lastname: Wyrick
authors.forename: Jay N
authors.initials: JN
authors.lastname: Lozier
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator