title: Catheter-directed thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis.
abstract: OBJECTIVE
  Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT.
  
  
  METHODS
  Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 ± 6 h of presentation. The dose of tPA was 0.75-1 mg/h through the infusion port and that of argatroban at 0.3-1 μg/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months.
  
  
  RESULTS
  There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE.
  
  
  CONCLUSIONS
  Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.
authors: Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA. seyedmohsensharifi@yahoo.com.|A. T. Still University, 5850 East Still Circle, Mesa, AZ, 85206, USA. seyedmohsensharifi@yahoo.com.
authors: Mohsen
authors: M
authors: Sharifi
authors: A. T. Still University, 5850 East Still Circle, Mesa, AZ, 85206, USA.
authors: Curt
authors: C
authors: Bay
authors: Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA.
authors: Sasan
authors: S
authors: Nowroozi
authors: Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA.
authors: Suzanne
authors: S
authors: Bentz
authors: Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA.
authors: Gayle
authors: G
authors: Valeros
authors: Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA.
authors: Sara
authors: S
authors: Memari
mesh_terms: D001120:Arginine / Q000031:analogs & derivatives; D002406:Catheterization, Peripheral / Q000379:methods*; D057785:Catheters; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007084:Iliac Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D010875:Pipecolic Acids / Q000008:administration & dosage / Q000627:therapeutic use*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D011152:Popliteal Vein / Q000000981:diagnostic imaging / Q000503:physiopathology; D012008:Recurrence; D012720:Severity of Illness Index; D013449:Sulfonamides; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
chemical_list: D005343:Fibrinolytic Agents; D010875:Pipecolic Acids; D010975:Platelet Aggregation Inhibitors; D013449:Sulfonamides; D001120:Arginine; D010959:Tissue Plasminogen Activator; C031942:argatroban