ACCELERATED THROMBOLYSIS WITH HIGH-DOSE BOLUS T-PA EXTENDS THE ROLE OF PERIPHERAL THROMBOLYSIS BUT MAY INCREASE THE RISKS

被引:15
作者
BRAITHWAITE, BD
BIRCH, PA
POSKITT, KR
HEATHER, BP
EARNSHAW, JJ
机构
[1] GLOUCESTERSHIRE ROYAL HOSP,GLOUCESTER GL1 3NN,ENGLAND
[2] CHELTENHAM GEN HOSP,CHELTENHAM,ENGLAND
关键词
D O I
10.1016/S0009-9260(05)83212-X
中图分类号
R8 [特种医学]; R445 [影像诊断学];
学科分类号
1002 ; 100207 ; 1009 ;
摘要
Low dose intra-arterial thrombolysis is too slow for many patients with severe acute limb ischaemia. Accelerated thrombolysis with high dose bolus t-PA was used in a consecutive series of 43 patients. Complete or clinically useful lysis was achieved in 39 patients, with a median duration of 7 h. Lysis occurred in 46% in under 4h. Fifty-six per cent of patients required further procedures after lysis. Eleven per cent suffered a major bleed. The limb salvage rate at 30 days was 56%. Amputation was required in 22% and 22% died. Most deaths were due to associated thrombotic conditions: myocardial infarction (5), pulmonary embolism (1) and malignant thrombosis (1). One patient died from pneumonia two weeks after lysis and two died from renal failure within a week of thrombolysis. The high mortality rate was not associated with bleeding but may reflect the high risks involved in treating this group of patients. High dose bolus t-PA infusion appears to predict immediate outcome of thrombolysis as well as reducing infusion times. It may expand the indications for the non-surgical treatment of acute limb ischaemia to include most patients with the condition. Careful case selection is still necessary for optimal results.
引用
收藏
页码:747 / 750
页数:4
相关论文
共 24 条
[1]   LOCAL LOW-DOSE INTRA-ARTERIAL THROMBOLYTIC THERAPY - THE RISK OF STROKE OR MAJOR HEMORRHAGE [J].
BERRIDGE, DC ;
MAKIN, GS ;
HOPKINSON, BR .
BRITISH JOURNAL OF SURGERY, 1989, 76 (12) :1230-1233
[2]   THROMBOLYSIS WITH TISSUE-PLASMINOGEN ACTIVATOR - RESULTS WITH A HIGH-DOSE TRANSTHROMBUS TECHNIQUE [J].
BRAITHWAITE, BD ;
ALKUTOUBI, A ;
BEARD, J ;
BERRIDGE, DC ;
BIRCH, PA ;
BUCKENHAM, T ;
DAWSON, K ;
DORMANDY, J ;
EARNSHAW, JJ ;
GAINES, PA ;
GALLAND, RB ;
HEATHER, BP ;
HAMILTON, G ;
JONES, L ;
PLATTS, A ;
TORRIE, P ;
WOLFE, J .
JOURNAL OF VASCULAR SURGERY, 1995, 21 (03) :540-540
[3]   ACCELERATED THROMBOLYSIS USING PULSED INTRATHROMBUS RECOMBINANT HUMAN TISSUE-TYPE PLASMINOGEN-ACTIVATOR (RT-PA) [J].
BUCKENHAM, TM ;
GEORGE, CD ;
CHESTER, JF ;
TAYLOR, RS ;
DORMANDY, JA .
EUROPEAN JOURNAL OF VASCULAR SURGERY, 1992, 6 (03) :237-240
[4]   RESULTS OF A RECENTLY INSTITUTED PROGRAM OF THROMBOLYTIC THERAPY IN ACUTE LOWER-LIMB ISCHEMIA [J].
DAWSON, KJ ;
REDDY, K ;
PLATTS, AD ;
HAMILTON, G .
BRITISH JOURNAL OF SURGERY, 1991, 78 (04) :409-411
[5]   A SIMPLIFIED PROCEDURE FOR INTRAARTERIAL THROMBOLYSIS WITH TISSUE-TYPE PLASMINOGEN-ACTIVATOR IN PERIPHERAL ARTERIAL OCCLUSIVE DISEASE - PRIMARY AND LONG-TERM RESULTS [J].
DECRINIS, M ;
PILGER, E ;
STARK, G ;
LAFER, M ;
OBERNOSTERER, A ;
LAMMER, J .
EUROPEAN HEART JOURNAL, 1993, 14 (03) :297-305
[6]  
EARNSHAW JJ, 1994, ANN ROY COLL SURG, V76, P219
[7]   LOCAL THROMBOLYTIC THERAPY OF ACUTE PERIPHERAL ARTERIAL ISCHEMIA WITH TISSUE PLASMINOGEN-ACTIVATOR - A DOSE-RANGING STUDY [J].
EARNSHAW, JJ ;
WESTBY, JC ;
GREGSON, RHS ;
MAKIN, GS ;
HOPKINSON, BR .
BRITISH JOURNAL OF SURGERY, 1988, 75 (12) :1196-1200
[8]   INTRAOPERATIVE USE OF THROMBOLYTIC AGENTS [J].
EARNSHAW, JJ ;
BEARD, JD .
BRITISH MEDICAL JOURNAL, 1993, 307 (6905) :638-639
[9]  
GAINES PA, 1991, BRIT J HOSP MED, V45, P343
[10]   ACUTE LIMB DETERIORATION DURING INTRAARTERIAL THROMBOLYSIS [J].
GALLAND, RB ;
EARNSHAW, JJ ;
BAIRD, RN ;
LONSDALE, RJ ;
HOPKINSON, BR ;
GIDDINGS, AEB ;
DAWSON, KJ ;
HAMILTON, G .
BRITISH JOURNAL OF SURGERY, 1993, 80 (09) :1118-1120