Hooi Kimberly S, Lemetayer Julie D
Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, N1G 2W1, Canada.
J Vet Emerg Crit Care (San Antonio). 2017 Sep;27(5):590-595. doi: 10.1111/vec.12627. Epub 2017 Jul 27.
To describe the use of alteplase for intravesicular thrombolysis in a dog after development of urinary tract obstruction from a blood clot in the urinary bladder.
A 5.8 kg, 6.5-year-old female neutered Bichon Frise was presented for signs of acute hematuria. A complete blood count (CBC) revealed marked thrombocytopenia and leukopenia, and nonregenerative anemia. Bone marrow aspirate cytology revealed mild hypercellularity, mild megakaryocytic hyperplasia, mildly left-shifted erythroid maturation, and moderately left-shifted myeloid maturation, suggesting ongoing recovery from an acute bone marrow insult. Thrombocytopenia and hematuria resolved concurrently; however, stranguria and oliguria developed acutely. Ultrasonography identified two large presumed thrombi within the urinary bladder. A urinary catheter was placed and 4 doses of 0.5 mg of alteplase diluted in 10 mL of 0.9% sodium chloride were instilled into the bladder with a 4-hour dwell time at 12-hour intervals. Prothombin and activated partial thromboplastin times were monitored during therapy and remained within normal limits. One thrombus was successfully dissolved after 48 hours of therapy and the remaining thrombus was reduced in size and was voided upon removal of the urinary catheter.
This report describes the use of alteplase in a dog for thrombolysis of intravesicular thrombi. In patients that develop intravesicular thrombi, intravesical instillation of alteplase can be considered as a method for dissolution of these thrombi.
描述在一只因膀胱血凝块导致尿路梗阻后使用阿替普酶进行膀胱内溶栓的情况。
一只5.8千克、6.5岁已绝育的雌性比熊犬因急性血尿症状前来就诊。全血细胞计数（CBC）显示明显的血小板减少和白细胞减少，以及非再生性贫血。骨髓穿刺细胞学检查显示轻度细胞增多、轻度巨核细胞增生、轻度左移的红细胞成熟以及中度左移的髓细胞成熟，提示正在从急性骨髓损伤中恢复。血小板减少和血尿同时得到缓解；然而，急性出现了排尿困难和少尿。超声检查在膀胱内发现两个大的疑似血栓。插入导尿管，并将4剂0.5毫克阿替普酶用10毫升0.9%氯化钠稀释后注入膀胱，停留时间为4小时，间隔12小时。治疗期间监测凝血酶原时间和活化部分凝血活酶时间，均保持在正常范围内。治疗48小时后，一个血栓成功溶解，剩余血栓体积减小，在拔除导尿管后排出。
本报告描述了在一只犬中使用阿替普酶进行膀胱内血栓溶栓的情况。对于发生膀胱内血栓的患者，膀胱内注入阿替普酶可被视为溶解这些血栓的一种方法。
