Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis

J Vasc Interv Radiol. 2011 Aug;22(8):1107-16. doi: 10.1016/j.jvir.2011.03.023. Epub 2011 Jun 12.

Abstract

Purpose: To evaluate the safety and efficacy of once-daily intraclot injections of low doses (≤ 10 mg) of tissue plasminogen activator (tPA) for thrombolysis of venous thrombosis.

Materials and methods: In prospective studies, 33 patients with subclavian, jugular, and central venous thrombosis (SJ-CVT) (all but two cases associated with central catheters) were treated once a day with ≤ 4 mg/day of tPA, and 30 patients with acute deep vein thrombosis of the lower extremity (DVT-LE) < 14 days old were treated once a day with ≤ 10 mg/leg/day of tPA by intraclot "lacing" of thrombus without continuous infusions of tPA.

Results: Patency was restored in 26 (79%) of 33 patients with SJ-CVT using an average total dose of 7.1 mg of tPA/per patient and average of 2.1 treatments or days of therapy. Five patients received thrombolytic therapy for SJ-CVT as outpatients. Initial patency was restored in 29 (97%) of 30 patients with acute DVT-LE using an average total dose of 20 mg of tPA per patient over an average of 2.7 treatments/or days per patient. Follow-up imaging examinations at 6 months showed continued patency in 27 (96%)/of 28 patients. There were no major bleeding complications, and no patient required a blood transfusion.

Conclusions: Intraclot injection of low doses of alteplase is effective for acute venous thrombosis, and pharmacokinetic data suggest potentially greater safety.

Publication types

  • Research Support, N.I.H., Intramural

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies
  • Tissue Plasminogen Activator / administration & dosage*
  • Treatment Outcome
  • Vascular Patency
  • Venous Thrombosis / drug therapy*

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator