Summary
Fibrinolytic parameters have been monitored in 44 patients undergoing local low-dose
intra-arterial thrombolysis for acute peripheral arterial ischaemia. Streptokinase
(Sk), at a dose of 5,000 units/hr with 250 units/hr heparin, was used in 23 patients
and recombinant tissue plasminogen activator (r-tPA) at a dose of 0.5 mg/hr was used
in 21 patients. Successful lysis was seen in 18 (86%) patients following r-tPA and
in 15 (65%) patients following streptokinase. There were 4 minor haematomas in each
group usually at the catheter entry site. Both agents produced a systemic effect,
which was still seen 12 hours post-infusion. However, that produced by r-tPA was delayed
and significantly reduced compared to that produced by Sk.
These results confirm the relative fibrin specificity of r-tPA. When used as a continuous
low-dose intra-arterial infusion, r-tPA offers a significantly lower, potentially
safer, systemic effect than conventional therapy with streptokinase.
Keywords
Acute peripheral ischaemia - Systemic fibrinolysis - Thrombolys - Recombinant tissue
plasminogen activator - Streptokinase
