Radiology and Imaging Sciences Department, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
J Vasc Interv Radiol. 2013 Jan;24(1):27-34.e1. doi: 10.1016/j.jvir.2012.09.017.
Seven patients with venous thrombosis and contraindications to traditional thrombolytic therapy, consisting of recent intracranial surgery, recent pineal or retroperitoneal hemorrhage, active genitourinary or gastrointestinal bleeding, epidural procedures, and impending surgery, were successfully treated with a modified thrombolytic regimen. To improve safety, prolonged continuous infusions of tissue plasminogen activator (tPA) was eliminated in favor of once-daily low-dose intraclot injections of tPA to minimize the amount and duration of tPA in the systemic circulation, and low-therapeutic or regional anticoagulation was used to reduce anticoagulant risks. These modifications may allow thrombolytic treatment for selected patients with severe venous thrombosis who are deemed to be at high risk.
7 例存在静脉血栓形成且对传统溶栓治疗有禁忌的患者，包括近期颅内手术、近期松果体或腹膜后出血、活动性泌尿生殖或胃肠道出血、硬膜外操作和即将进行的手术，均成功采用改良溶栓方案进行了治疗。为提高安全性，我们摒弃了持续输注组织型纤溶酶原激活剂（tPA）的方法，转而采用每日一次的低剂量血栓内注射 tPA，以尽量减少 tPA 在全身循环中的量和时间，同时使用低治疗剂量或区域性抗凝来降低抗凝风险。这些改良方法可能允许对被认为存在高风险的特定重症静脉血栓形成患者进行溶栓治疗。
