title: Early versus late thrombolysis in acute arterial occlusion of lower extremity.
abstract: BACKGROUND
  Acute arterial occlusion in lower extremity is an urgent condition which occurs when there is an abrupt interruption of blood flow into an extremity. Reperfusion through early intervention can increase limb salvage and decrease mortality. There was no common agreement when is the best to start thrombolysis in treating acute arterial occlusion. This study was designed to study the efficacy of an early thrombolysis compared with a late thrombolysis.
  
  
  METHODS
  We identified all patients discharged from the Gwangju Veterans hospital with a diagnosis of acute arterial occlusion between 2006 and 2014. 72 patients were eligible, and every patient had treated with catheter-directed thrombolysis on the day or 1day after admission. Among them, 42 patients had undergone an early thrombolysis (less than 7days after the onset of symptoms) and the other 30 patients had undergone a late thrombolysis (more than 7days after the onset of symptoms). The primary outcome was amputation rate at 6months. The secondary outcomes were all cause mortality at 6months and increase of ankle brachial index (ABI).
  
  
  RESULTS
  Amputation rate at 180days in the early thrombolysis group was 7.1% as compared with 30% in the late thrombolysis group. All cause mortality at 6months and increase of ABI were not different between two groups. In multivariable Cox-regression analysis, late thrombolysis was independent predictor of amputation at 6months.
  
  
  CONCLUSIONS
  Early thrombolysis was superior in preventing amputation than late thrombolysis.
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Hyun Gee
authors.initials: HG
authors.lastname: Moon
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea. Electronic address: bestcheol@daum.net.
authors.forename: Sang Cheol
authors.initials: SC
authors.lastname: Cho
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Jeong
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Gyu Ik
authors.initials: GI
authors.lastname: Lee
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Young Eun
authors.initials: YE
authors.lastname: Jo
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Boram
authors.initials: B
authors.lastname: Youn
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Won Yu
authors.initials: WY
authors.lastname: Kang
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Sun Ho
authors.initials: SH
authors.lastname: Hwang
authors.affiliation: Department of Cardiology, Gwangju Veterans Hospital, Gwangju, Korea.
authors.forename: Wan
authors.initials: W
authors.lastname: Kim
authors.affiliation: Department of Cardiology, Kyung Hee University Hospital, Seoul, Korea.
authors.forename: Weon
authors.initials: W
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D061345:Early Medical Intervention / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D023821:Limb Salvage / Q000379:methods; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute arterial occlusion; Early versus late; Thrombolysis