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August 1994

Peripheral Thrombolysis With Tissue Plasminogen Activator: Results of Two Treatment Regimens

Author Affiliations

From the Department of Surgery, Basingstoke (England) District Hospital (Drs Ward and Andaz), and the Wessex Cancer Intelligence Unit, Winchester, England (Mr By grave).

Arch Surg. 1994;129(8):861-865. doi:10.1001/archsurg.1994.01420320087017

Objective:  The purpose of this study was to document the response to tissue plasminogen activator given as either a low-dose intra-arterial infusion or a bolus infusion in patients with peripheral arterial or bypass graft occlusion.

Design:  Fifty thrombolytic procedures were carried out in 45 patients with a recent occlusion of a peripheral artery (41) or bypass graft (nine). A continuous infusion of 1.0 mg/h of tissue plasminogen activator was used in 27 patients (group A), while 23 patients were given a 20-mg bolus followed by an infusion of 1.0 mg/h (group B). Patients in the two groups were followed up for 12.1±9.3 months and 11.1±9.1 months, respectively.

Results:  In group A, the angiographic lysis rate was 74% and clinical success rate was 67%. In group B, the comparable rates were 70% and 48%. Lysis was quicker when a bolus infusion was used, the mean lysis time being 14.4±7.9 hours compared with 26.7±9.4 hours following infusion alone (P=.0005). There was one instance of major hemorrhage in group A and eight in group B (P=.0022), including two patients with cerebral hemorrhage, one of whom died.

Conclusion:  Low-dose tissue plasminogen activator infusion is safe and reasonably effective, although a long treatment time is required. A bolus infusion regimen speeds lysis but is attended by a high incidence of serious hemorrhage.(Arch Surg. 1994;129:861-865)

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