Duszak R, Sacks D
Department of Radiology, The Reading Hospital and Medical Center, PA 19612-6052, USA.
J Vasc Interv Radiol. 1999 Feb;10(2 Pt 1):123-8. doi: 10.1016/s1051-0443(99)70453-7.
"Lyse and wait" dialysis graft declotting is simple and effective, but the minimum necessary dose of urokinase is unknown. The efficacy of the technique with very low dose urokinase is evaluated.
Twenty-one grafts in 17 patients were declotted with use of the lyse and wait technique, but with 5,000-15,000 U of urokinase initially. Graft angiography was performed when an interventional suite was available. Declotting was completed in the manner chosen by the individual operator. Angiograms, interventional radiology records, and dialysis records were reviewed.
Technical and clinical success were achieved in 95% of cases. Mean initial urokinase dose was 6,667 U. Initial angiography was performed at a mean 86 minutes. Two cases required second 5,000-U boluses to achieve complete graft thrombolysis. In all other cases, complete or near complete graft thrombolysis was observed with the initial very low dose. No bleeding, arterial embolic, or pulmonary embolic complications were observed.
Doses of urokinase as low as 5,000 U are effective for lyse and wait declotting. A substantial reduction in drug costs can be expected with the "less and wait" modification. Bleeding risk may also be reduced.
“溶解并等待”法进行动静脉内瘘溶栓操作简单且有效，但尿激酶的最小必要剂量尚不清楚。本研究评估了极低剂量尿激酶技术的疗效。
17例患者的21个动静脉内瘘采用“溶解并等待”技术进行溶栓，初始使用5000 - 15000单位尿激酶。有介入设备时进行内瘘血管造影。溶栓操作由各操作者自行选择方式完成。回顾血管造影片、介入放射学记录及透析记录。
95%的病例获得技术和临床成功。平均初始尿激酶剂量为6667单位。平均在86分钟时进行初始血管造影。2例需要再次推注5000单位尿激酶以实现完全内瘘溶栓。在所有其他病例中，初始极低剂量时观察到完全或接近完全的内瘘溶栓。未观察到出血、动脉栓塞或肺栓塞并发症。
低至5000单位的尿激酶剂量对“溶解并等待”溶栓有效。采用“少用并等待”的改良方法有望大幅降低药物成本。出血风险也可能降低。
