title: Treatment of high-risk venous thrombosis patients using low-dose intraclot injections of recombinant tissue plasminogen activator and regional anticoagulation.
abstract: Seven patients with venous thrombosis and contraindications to traditional thrombolytic therapy, consisting of recent intracranial surgery, recent pineal or retroperitoneal hemorrhage, active genitourinary or gastrointestinal bleeding, epidural procedures, and impending surgery, were successfully treated with a modified thrombolytic regimen. To improve safety, prolonged continuous infusions of tissue plasminogen activator (tPA) was eliminated in favor of once-daily low-dose intraclot injections of tPA to minimize the amount and duration of tPA in the systemic circulation, and low-therapeutic or regional anticoagulation was used to reduce anticoagulant risks. These modifications may allow thrombolytic treatment for selected patients with severe venous thrombosis who are deemed to be at high risk.
authors.affiliation: Radiology and Imaging Sciences Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA. rchang@cc.nih.gov
authors.forename: Richard
authors.initials: R
authors.lastname: Chang
authors.forename: John A
authors.initials: JA
authors.lastname: Butman
authors.forename: Russell R
authors.initials: RR
authors.lastname: Lonser
authors.forename: Richard M
authors.initials: RM
authors.lastname: Sherry
authors.forename: Prakash K
authors.initials: PK
authors.lastname: Pandalai
authors.forename: McDonald K
authors.initials: MK
authors.lastname: Horne
authors.forename: Jay N
authors.initials: JN
authors.lastname: Lozier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000008:administration & dosage; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000235:genetics; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000188:drug therapy*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator