Turpie A G, Levine M N, Hirsh J, Ginsberg J S, Cruickshank M, Jay R, Gent M
Department of Medicine, McMaster University, Hamilton, Canada.
Chest. 1990 Apr;97(4 Suppl):172S-175S.
We performed a randomized trial comparing two dosing regimens of recombinant tissue plasminogen activator (rt-PA) plus heparin vs heparin alone in the treatment of acute proximal deep vein thrombosis in 83 patients. Of 12 patients who received 0.5 mg/kg rt-PA plus heparin over 4 h, seven (58 percent) had greater than 50 percent lysis of the thrombus, compared with none of 12 who received placebo plus heparin (p = 0.002). Of 28 patients who received 0.5 mg/kg rt-PA over 8 h, repeated in 24 h, six (21 percent) had greater than 50 percent lysis, compared with two (7 percent) of 30 patients who received placebo plus heparin (p = 0.11). The 4-h infusion of rt-PA produced a 40 percent reduction and the 8-h infusion an 11 percent reduction in plasma fibrinogen concentration. At long-term follow-up, three (25 percent) of 12 patients in whom greater than 50 percent lysis was achieved had symptoms of the postphlebitic syndrome, compared with 19 (56 percent) of 34 patients in whom lysis was less than 50 percent (p = 0.07).
我们进行了一项随机试验，比较重组组织型纤溶酶原激活剂（rt-PA）加肝素的两种给药方案与单独使用肝素治疗83例急性近端深静脉血栓形成的疗效。在12例接受4小时内0.5mg/kg rt-PA加肝素治疗的患者中，7例（58%）血栓溶解超过50%，而12例接受安慰剂加肝素治疗的患者中无一例血栓溶解超过50%（p = 0.002）。在28例接受8小时内0.5mg/kg rt-PA治疗（24小时后重复给药）的患者中，6例（21%）血栓溶解超过50%，而30例接受安慰剂加肝素治疗的患者中有2例（7%）血栓溶解超过50%（p = 0.11）。rt-PA 4小时输注使血浆纤维蛋白原浓度降低40%，8小时输注使血浆纤维蛋白原浓度降低11%。在长期随访中，血栓溶解超过50%的12例患者中有3例（25%）出现了静脉炎后综合征症状，而血栓溶解低于50%的34例患者中有19例（56%）出现了静脉炎后综合征症状（p = 0.07）。
