Meyerovitz M F, Goldhaber S Z, Reagan K, Polak J F, Kandarpa K, Grassi C J, Donovan B C, Bettmann M A, Harrington D P
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115.
Radiology. 1990 Apr;175(1):75-8. doi: 10.1148/radiology.175.1.2107563.
A randomized prospective trial was undertaken to compare intraarterial administration of recombinant human tissue-type plasminogen activator (rt-PA) with urokinase (UK) in 32 patients with peripheral arterial or bypass graft occlusions. Sixteen patients were randomized to receive rt-PA and 16 to receive UK. The rt-PA dose was administered as a 10-mg bolus into the thrombus, followed by 5 mg/h for up to 24 hours. The UK dose was administered as a 60,000 IU bolus into the thrombus, followed by 240,000 IU/h for 2 hours, 120,000 IU/h for 2 hours, and 60,000 IU/h for up to 20 hours. Serial arteriograms were obtained at baseline and at 4, 8 or 16, and 24 hours. The endpoint was defined as 95% of greater clot lysis. The cumulative numbers of patients with successful thrombolysis (rt-PA vs UK) were four vs none at 4 hours, seven vs one at 8 hours, seven vs three at 16 hours, and eight vs six at 24 hours. Lysis occurred more rapidly in the rt-PA group (P = .04). Major bleeding complications occurred in five rt-PA patients and two UK patients (P = .39). At 24 hours, fibrinogen levels were significantly lower in the rt-PA group than in the UK group (P = .01). There was no apparent difference in 30-day clinical success.
进行了一项随机前瞻性试验，比较重组人组织型纤溶酶原激活剂（rt-PA）与尿激酶（UK）动脉内给药治疗32例外周动脉或旁路移植血管闭塞患者的效果。16例患者随机接受rt-PA治疗，16例接受UK治疗。rt-PA剂量为10mg静脉推注至血栓内，随后以5mg/h持续给药24小时。UK剂量为60,000IU静脉推注至血栓内，随后2小时内以240,000IU/h给药，接下来2小时内以120,000IU/h给药，最多20小时内以60,000IU/h给药。在基线以及4、8或16和24小时时进行系列动脉造影。终点定义为血栓溶解95%或更高。成功溶栓的累积患者数（rt-PA组与UK组）在4小时时为4例对0例，8小时时为7例对1例，16小时时为7例对3例，24小时时为8例对6例。rt-PA组溶栓发生更快（P = 0.04）。5例rt-PA患者和2例UK患者发生了严重出血并发症（P = 0.39）。24小时时，rt-PA组纤维蛋白原水平显著低于UK组（P = 0.01）。30天临床成功率无明显差异。
