Department of Interventional Radiology, Pomeranian Academy of Medicine, Szczecin, Poland.
Eur J Vasc Endovasc Surg. 2013 Jul;46(1):118-23. doi: 10.1016/j.ejvs.2013.04.016. Epub 2013 May 16.
The evaluation of success and complication rates of ultra high-dose recombinant tissue plasminogen activator (rt-PA) administered over a short time frame in the treatment of acute lower limb ischemia.
This was a prospective single-center study. The outcome of treatment in 97 patients with acute limb ischemia (<14 days) with the use of catheter directed rt-PA infusion was evaluated. The mean total dose of rt-PA was 54.1 mg (50-60 mg) and was administered for a mean of 2.51 hours (2-4 hours). Thrombolytic success was defined as 95% thrombolysis of an occluded segment with return of antegrade flow. Thirty-day complication and amputation-free survival rates were calculated.
Thrombolytic success was achieved in 83.5%. Overall clinical success was 88.7%. The 30-day amputation-free survival rate was 93.8%. Major bleeding complications occurred in 10 patients (10.3%). There were two deaths (2.1%) and four amputations (4.1%). Long-term amputation-free survival was 70%.
Administration of ultra-high doses of rt-PA over a short time period gives promising results. Such delivery improves patient tolerance by rapid restoration of limb perfusion; however further studies are required to confirm these results.
评估在短时间内给予超高剂量重组组织型纤溶酶原激活剂（rt-PA）治疗急性下肢缺血的成功率和并发症发生率。
这是一项前瞻性单中心研究。评估了 97 例急性肢体缺血（<14 天）患者使用导管定向 rt-PA 输注的治疗结果。rt-PA 的平均总剂量为 54.1mg（50-60mg），平均给药时间为 2.51 小时（2-4 小时）。溶栓成功定义为闭塞段 95%的血栓溶解，前向血流恢复。计算 30 天并发症和无截肢生存率。
溶栓成功率为 83.5%。总体临床成功率为 88.7%。30 天无截肢生存率为 93.8%。10 例（10.3%）发生大出血并发症。有 2 例死亡（2.1%）和 4 例截肢（4.1%）。长期无截肢生存率为 70%。
在短时间内给予超高剂量 rt-PA 可取得良好的效果。这种给药方式通过快速恢复肢体灌注提高了患者的耐受性；然而，需要进一步的研究来证实这些结果。
