Parikh Sanjiv, Motarjeme Amir, McNamara Thomas, Raabe Rodney, Hagspiel Klaus, Benenati James F, Sterling Keith, Comerota Anthony
Department of Interventional Radiology, Swedish Medical Center-Cherry Hill Campus, Seattle, WA 98122, USA.
J Vasc Interv Radiol. 2008 Apr;19(4):521-8. doi: 10.1016/j.jvir.2007.11.023.
To evaluate the success of lysis and clinical outcomes in patients treated with ultrasound (US)-accelerated thrombolysis for deep vein thrombosis (DVT).
Forty-seven patients with 53 cases of DVT were treated with US-accelerated thrombolysis at eight centers in the United States. Sixty percent of the occlusions were in the lower extremity, 36% were in the upper extremity, and 4% were hepatic. The clot was acute (< or =14 days) in 47% of cases, subacute (15-28 d) in 8%, chronic (>28 d) in 17%, acute-on-chronic in 17%, and not specified in 11%. Patients were treated with urokinase (UK), tissue plasminogen activator (tPA), recombinant plasminogen activator (rPA), or tenecteplase.
Complete lysis (> or =90%) was seen in 37 of 53 cases (70%) and overall lysis (complete plus partial) was seen in 48 (91%). No lysis occurred in five cases (9%), four of which were chronic. The median thrombolysis infusion time was 22.0 hours. Major complications (hematoma at site of earlier surgery) occurred in only two patients (3.8%), with no incidence of intracranial or retroperitoneal hemorrhage. US-accelerated thrombolysis exhibited comparable or better lysis with a lower average drug dose and shorter median treatment times than reported in the National Venous Registry and a more recently published study of standard catheter-directed thrombolysis.
US-accelerated thrombolysis was shown to be a safe and efficacious treatment for DVT in this multicenter experience. The addition of US reduces total infusion time and provides a greater incidence of complete lysis with a reduction in bleeding rates.
评估采用超声（US）加速溶栓治疗深静脉血栓形成（DVT）患者的溶栓成功率及临床结局。
美国8个中心的47例患有53例DVT的患者接受了US加速溶栓治疗。60%的闭塞位于下肢，36%位于上肢，4%位于肝脏。47%的病例血栓为急性（≤14天），8%为亚急性（15 - 28天），17%为慢性（>28天），17%为慢性基础上急性发作，11%未明确说明。患者接受尿激酶（UK）、组织型纤溶酶原激活剂（tPA）、重组纤溶酶原激活剂（rPA）或替奈普酶治疗。
53例中有37例（70%）实现完全溶解（≥90%），48例（91%）实现总体溶解（完全溶解加部分溶解）。5例（9%）未发生溶解，其中4例为慢性血栓。溶栓输注的中位时间为22.0小时。主要并发症（既往手术部位血肿）仅发生在2例患者（3.8%），未发生颅内或腹膜后出血。与国家静脉注册研究及最近发表的一项标准导管导向溶栓研究相比，US加速溶栓在平均药物剂量更低、中位治疗时间更短的情况下，实现了相当或更好的溶解效果。
在这项多中心研究中，US加速溶栓被证明是治疗DVT的一种安全有效的方法。超声的加入减少了总输注时间，提高了完全溶解的发生率，并降低了出血率。
