Faculty Collaboration Database

Catheter-directed thrombolytic therapy in peripheral artery occlusions: combining reteplase and abciximab. AJR Am J Roentgenol 2003 May;180(5):1385-91

Date

04/22/2003

Pubmed ID

12704056

DOI

10.2214/ajr.180.5.1801385

Scopus ID

2-s2.0-0242600612 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

OBJECTIVE: The goal of this study was to assess the safety and efficacy of combination therapy consisting of the third-generation plasminogen activator reteplase and the glycoproteins IIb and IIIa platelet receptor antagonist abciximab for thrombolysis in peripheral artery occlusive disease. This two-center experience focused on immediate thrombolytic success, thrombolysis time, complication rate, and 30-day patency rate.

SUBJECTS AND METHODS: Fifty patients with arterial occlusive disease (age range, 40-96 years; mean age, 69 years) were prospectively enrolled at two centers. Eighteen patients (36%) had native artery thromboses, and 32 patients (64%) had graft thromboses. Catheter-directed intraarterial thrombolytic infusion of reteplase (average dose, 0.51 U/hr; range, 0.25-1 U/hr) was combined with IV infusion of abciximab (bolus, 0.25 mg/kg of body weight; 12-hr infusion, 0.125 microg/kg of body weight per minute). Nontherapeutic heparin (100-400 U/hr) was given intraarterially during the thrombolytic infusion.

RESULTS: Complete thrombolysis was achieved in 89% of the patients with native artery occlusions and 94% of the patients with graft occlusions for an overall rate of 92%. The average thrombolysis time was 20.7 hr (range, 4-41 hr) with a mean reteplase dose of 12.1 U (range, 2-23 U). Major hematoma occurred in 12% of the patients, with an average blood transfusion of 3.1 U of packed RBC (range, 1-11 U), and correlated to increased thrombolysis time and dose. No intracranial hemorrhage occurred. The 30-day primary patency rate was 92%. Two patients (4%) underwent amputation, including one major amputation (2%), within 30 days of thrombolysis.

CONCLUSION: The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. Results of this combination therapy suggest acceptable thrombolysis times and doses with tolerable complication rates. Which patient group might benefit the most from combination therapy and the long-term results of combination therapy still need to be determined.

Author List

Drescher P, McGuckin J, Rilling WS, Crain MR

Author

William S. Rilling MD, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Antibodies, Monoclonal
Anticoagulants
Arterial Occlusive Diseases
Catheterization
Drug Therapy, Combination
Female
Fibrinolytic Agents
Humans
Immunoglobulin Fab Fragments
Male
Middle Aged
Recombinant Proteins
Thrombolytic Therapy
Tissue Plasminogen Activator