ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2002 December;43(6):881-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Low dose systemic thrombolytic therapy for treatment of deep venous thrombosis

Ugurlu B., Kazaz H., Oto O., Hazan E., Sariosmanoglu N.

Dokuz Eylul University Medical School Department of Thoracic and Cardiovascular Surgery Izmir, Turkey

Background. Thrombolytic ther­a­py is ­still ­not ­used wide­ly ­for treat­ment of ­deep ­vein throm­bo­sis ­despite ­its ­known effi­ca­cy. This reluc­tance to ­use it ­stems ­from wor­ries ­about ­its hemor­rhag­ic com­pli­ca­tions.
Methods. In a 4-­year peri­od 97 ­patients ­with ­deep ­vein throm­bo­sis diag­nosed by ­duplex ­study ­were ­enrolled ­into ­the ­study. Fifty ­patients ­received strep­tok­i­nase as a ­bolus of 250,000 ­units fol­lowed by 100,000 ­units/hr ­with a max­i­mum of 4,000,000 ­units ­and 47 ­patients ­received anti­co­ag­u­la­tion ­with hep­ar­in.
Results. Minor hemor­rhag­ic com­pli­ca­tions ­occurred in 2 ­patients (4%) in ­the throm­bo­lyt­ic ther­a­py ­group. An improve­ment in ­the con­trol ­duplex ­study ­was ­observed in 56% of ­the ­patients in ­the throm­bo­lyt­ic ther­a­py ­group com­pared to 5% in ­the hep­ar­in ­group (p=0.000). The ­patients treat­ed with­in 4 ­days of ­onset of symp­toms ­had sig­nif­i­cant­ly high­er suc­cess ­rates com­pared to ­those treat­ed lat­er (p=0.000). Higher suc­cess ­rates ­were ­obtained ­for ­those ­with ­either femo­ral ­vein or ­more dis­tal ­venous throm­bo­sis com­pared to ­those ­with ­iliac ­vein ­and ­vena ­cava throm­bo­sis (p=0.007). These ­results ­show ­that system­ic ­low ­dose strep­tok­i­nase ­achieves sig­nif­i­cant­ly high­er rec­a­nal­iza­tion ­rates com­pared to hep­ar­in ­alone. Conclusions. Hemorrhagic com­pli­ca­tions at ­these ­dose lev­els ­are with­in accept­able rang­es. Low ­dose strep­tok­i­nase reg­i­men ­could be beni­fi­cial in ­patients ­who ­present with­in 4 ­days of femo­ral or ­more dis­tal ­venous throm­bo­sis.