Arizona Cardiovascular Consultants, 3850 E Baseline Road, Bldg1, Suite 102, Mesa, AZ, 85206, USA.
A. T. Still University, 5850 East Still Circle, Mesa, AZ, 85206, USA.
Cardiovasc Intervent Radiol. 2013 Dec;36(6):1586-1590. doi: 10.1007/s00270-013-0569-3. Epub 2013 Feb 2.
Catheter-directed thrombolysis (CDT) is a highly effective approach in the treatment of deep venous thrombosis (DVT). There are no data on the primary use of CDT with argatroban and tissue plasminogen activator (tPA) in patients without heparin-induced thrombocytopenia (HIT). The aim of this study was to evaluate the efficacy and safety of the combined administration of argatroban and tPA during CDT for massive DVT in patients without HIT.
Thirty-three patients with massive symptomatic iliac and femoropopliteal DVT underwent CDT with tPA and argatroban within 28 ± 6 h of presentation. The dose of tPA was 0.75-1 mg/h through the infusion port and that of argatroban at 0.3-1 μg/kg/min through the side port of the sheath. The patients were evaluated for the efficacy and safety of CDT and recurrent symptomatic venous thromboembolism (VTE) at a mean follow-up of 22 months.
There was no bleeding or iatrogenic pulmonary embolism with the CDT regimen we used. Grade III lysis (complete resolution of thrombus on venography) was achieved in 30 patients (91 %). In 3 patients with additional inferior vena cava filter thrombosis, further thrombectomy of the filter was required. No patient developed recurrent VTE.
Concomitant administration of argatroban and tPA is a highly safe and effective regimen for CDT for massive DVT.
导管溶栓（CDT）是治疗深静脉血栓形成（DVT）的一种非常有效的方法。目前尚无关于在无肝素诱导血小板减少症（HIT）的患者中，使用阿加曲班和组织型纤溶酶原激活剂（tPA）进行首次 CDT 的数据。本研究旨在评估在无 HIT 的大量 DVT 患者中，联合使用阿加曲班和 tPA 进行 CDT 的疗效和安全性。
33 例有症状的髂股和腘静脉血栓形成的大量患者在发病后 28 ± 6 小时内行 CDT 治疗，同时使用 tPA 和阿加曲班。tPA 的剂量为 0.75-1mg/h 通过输注端口，阿加曲班的剂量为 0.3-1μg/kg/min 通过鞘的侧端口。在平均 22 个月的随访中，评估 CDT 和复发性有症状静脉血栓栓塞症（VTE）的疗效和安全性。
我们使用的 CDT 方案没有出血或医源性肺栓塞。30 例患者（91%）达到了 3 级溶解（静脉造影完全清除血栓）。在 3 例伴有额外下腔静脉滤器血栓形成的患者中，需要进一步进行滤器血栓切除术。没有患者发生复发性 VTE。
阿加曲班和 tPA 同时给药是治疗大量 DVT 的 CDT 的一种安全有效的方案。
