Grunwald Michael R, Hofmann Lawrence V
The Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Blalock 545, 600 N Wolfe Street, Baltimore, Maryland 21287, USA.
J Vasc Interv Radiol. 2004 Apr;15(4):347-52. doi: 10.1097/01.rvi.0000121407.46920.15.
To compare the efficacy, safety, and costs associated with catheter-directed thrombolysis with urokinase (UK) and the recombinant agents alteplase (tissue plasminogen activator [TPA]) and reteplase (recombinant plasminogen activator [RPA]) in the treatment of symptomatic deep vein thrombosis (DVT).
The authors conducted a retrospective analysis on 74 patients (82 limbs) who underwent treatment for DVT. Thrombosed extremities were treated with either urokinase with therapeutic heparin dosing (UK group; 38 limbs), alteplase with subtherapeutic heparin dosing (TPA group; 32 limbs), or reteplase with subtherapeutic heparin dosing (RPA group; 12 limbs). Infusion times, dosages, drug costs, success rates, and complications were compared among the groups.
Gender, age, disease location, duration of symptoms, and use of additional interventional therapies did not differ statistically among the three cohorts. Median hourly infused doses, total doses, infusion times, drug costs, and success rates per limb were: UK, 11.3 (10(4)) U/hour, 4.361 million U, 40.6 hours, US dollars 6577, 97.4%; TPA, 0.57 mg/hour, 21.6 mg, 30.8 hours, US dollars 488, 96.9%; RPA, 0.74 U/hour, 21.4 U, 24.3 hours, US dollars 1787, 100.0%. Major and overall complication rates were: UK, 5.3% and 10.5%; TPA, 3.1% and 12.5%; RPA, 8.3% and 16.7%. Infusion times, success rates, and complications were not statistically different among the three groups. Alteplase and reteplase were significantly less expensive than urokinase (P <.001 and P <.01, respectively).
Catheter-directed thrombolysis for the treatment of DVT is safe and effective, regardless of the agent used. However, the new recombinant agents are significantly less expensive than urokinase.
比较尿激酶（UK）、重组组织型纤溶酶原激活剂（alteplase，tPA）和重组纤溶酶原激活剂（reteplase，RPA）导管定向溶栓治疗有症状的深静脉血栓形成（DVT）的疗效、安全性和成本。
作者对74例接受DVT治疗的患者（82条肢体）进行了回顾性分析。血栓形成的肢体分别接受尿激酶联合治疗剂量肝素（UK组；38条肢体）、阿替普酶联合亚治疗剂量肝素（TPA组；32条肢体）或瑞替普酶联合亚治疗剂量肝素（RPA组；12条肢体）治疗。比较各组的输注时间、剂量、药物成本、成功率和并发症。
三组患者的性别、年龄、病变部位、症状持续时间和是否使用其他介入治疗在统计学上无差异。每组肢体的中位每小时输注剂量、总剂量、输注时间、药物成本和成功率分别为：UK组，11.3（10⁴）U/小时，436.1万U，40.6小时，6577美元，97.4%；TPA组，0.57mg/小时，21.6mg，30.8小时，488美元，96.9%；RPA组，0.74U/小时，21.4U，24.3小时，1787美元，100.0%。严重并发症和总体并发症发生率分别为：UK组，5.3%和10.5%；TPA组，3.1%和12.5%；RPA组，8.3%和16.7%。三组之间的输注时间、成功率和并发症在统计学上无差异。阿替普酶和瑞替普酶的成本明显低于尿激酶（分别为P <.001和P <.01）。
无论使用何种药物，导管定向溶栓治疗DVT都是安全有效的。然而，新型重组药物的成本明显低于尿激酶
