School of Medicine, Ordu University, Ordu, Turkey. Email:
Çanakkale Onsekiz Mart University, Çanakkale, Turkey.
Cardiovasc J Afr. 2020 Nov-Dec;31(6):286-290. doi: 10.5830/CVJA-2020-020. Epub 2020 Jun 19.
The aim of this study was to investigate the impact of accelerated pharmaco-mechanical thrombolysis (PMT) with low-dose second-generation urokinase for the management of cases with lower-extremity deep venous thrombosis (DVT), and to compare its efficacy in subjects with acute and subacute DVT.
Thirty-five patients with acute (< 15 days) or subacute (15-30 days) DVT who underwent PMT in a tertiary centre were enrolled in this single-arm, prospective study. Following the placement of a temporary vena cava filter, urokinase (200 000 IU) was administered into the occlusion through a multi-hole catheter for 15 to 20 minutes. Control venography was performed to assess venous flow and the rate of acute recanalisation. Percutaneous balloon dilatation and stent placement were carried out in case of a residual iliac vein stenosis of > 50%. Any residual thrombi were suctioned with an aspiration catheter. The primary outcome measures of this study were the percentages of vessel patency and PTS in the third month after PMT.
Complete recanalisation was noted in 23 (66%) patients, while two (6%) had poor recanalisation. The rate of minor complications was 14%. None of the subjects experienced major complications, such as intracranial haemorrhage or pulmonary embolism. No mortality was recorded during the three months of follow up. Control duplex ultrasonography in the third month revealed that the target vein was patent in all subjects. None of the subjects experienced PTS during follow up. In addition, the percentage of acute complete recanalisation was significantly higher in subjects with acute DVT compared to those with subacute DVT (95 vs 27%, p < 0.001).
PMT with an accelerated regimen of low-dose urokinase provided excellent efficacy in the resolution of thrombus and prevented the development of PTS in the midterm when used for the management of lower-extremity DVT.
本研究旨在探讨采用低剂量第二代尿激酶加速的药物机械血栓溶解（PMT）治疗下肢深静脉血栓形成（DVT）的效果，并比较其在急性和亚急性 DVT 患者中的疗效。
在一家三级中心，对 35 例接受 PMT 的急性（<15 天）或亚急性（15-30 天）DVT 患者进行了这项单臂、前瞻性研究。在放置临时腔静脉滤器后，通过多孔导管将尿激酶（200000IU）注入闭塞部位 15-20 分钟。进行控制静脉造影以评估静脉血流和急性再通率。如果髂静脉残余狭窄>50%，则进行经皮球囊扩张和支架置入。用抽吸导管抽吸任何残留血栓。本研究的主要终点是 PMT 后第三个月的血管通畅率和 PTS 发生率。
23 例（66%）患者完全再通，2 例（6%）患者再通不良。轻微并发症发生率为 14%。所有患者均未发生颅内出血或肺栓塞等严重并发症。在 3 个月的随访期间，无死亡病例。第三个月的控制双功能超声检查显示，所有患者的靶静脉均通畅。在随访期间，所有患者均未发生 PTS。此外，急性 DVT 患者的急性完全再通率明显高于亚急性 DVT 患者（95% vs 27%，p<0.001）。
采用低剂量尿激酶加速方案的 PMT 在解决血栓方面具有优异的效果，并可预防下肢 DVT 中期 PTS 的发生。
