title: Low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is effective without major hemorrhagic complications.
abstract: OBJECTIVE
  To evaluate the efficacy and bleeding complications associated with a low-dose thrombolysis protocol for thromboembolic lower extremity arterial occlusions.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A retrospective analysis was performed using data from all consecutive patients who underwent catheter-directed, intra-arterial thrombolysis for thromboembolic lower extremity arterial occlusions between January 2004 and May 2013. All patients were treated on a standard surgical ward. Endpoints were incidence of bleeding complications, duration of thrombolysis, angiographic patency rate, 30-day mortality rate, and amputation-free rate at 6 months.
  
  
  RESULTS
  Of the 171 cases analyzed, 129 cases underwent low-dose thrombolysis and 42 underwent high-dose thrombolysis. No major bleeding complications occurred in the low-dose group versus 5% in the high-dose group (p = .01). The median duration of thrombolysis was 67 hours (4-304 hours) in the low-dose and 49 hours (2-171 hours) in the high-dose group (p = .027). Angiographic patency was restored in 67% of the cases in the low-dose group versus 79% of the high-dose group (p = .17). The 30-day mortality rates were 1% in the low-dose versus 5% in the high-dose group (p = .09). However, this higher mortality rate was not related to bleeding complications. Major amputation-free rates at 6 months were 81% in the low-dose group and 88% in the high-dose group (p = .22).
  
  
  CONCLUSIONS
  Based on this data series, low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is as effective as high-dose thrombolysis; however, the risk of major bleeding complications is substantially lower when using low-dose thrombolysis.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: H P
authors.initials: HP
authors.lastname: Ebben
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: J H
authors.initials: JH
authors.lastname: Nederhoed
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: R J
authors.initials: RJ
authors.lastname: Lely
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: M R
authors.initials: MR
authors.lastname: Meijerink
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: B B
authors.initials: BB
authors.lastname: van der Meijs
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Wisselink
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: K K
authors.initials: KK
authors.lastname: Yeung
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: a.hoksbergen@vumc.nl.
authors.forename: A W J
authors.initials: AW
authors.lastname: Hoksbergen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000009:adverse effects
chemical_list: D005343:Fibrinolytic Agents
keywords: Embolism and thrombosis; Endovascular procedures; Hemorrhage; Peripheral arterial occlusive disease; Thrombolytic therapy; Urokinase-type plasminogen activator