Peripheral arterial thrombosis, treatment

Duda SH, Tepe G, Luz O, et al. Peripheral artery occlusion treatment with abciximab plus urokinase versus with urokinase alone—a randomized pilot trial (the PROMPT Study). Platelet receptor antibodies in order to manage peripheral artery thrombosis, radiology 2001 221 (3) 689—696. 

Therapeutic uses Originally used for the treatment of deep-vein thrombosis and serious pulmonary embolism, thrombolytic drugs are now being used with increasing frequency to treat acute myocardial infarction and peripheral arterial thrombosis and emboli, and for unclotting catheters and shunts. 

Prevention and treatment of venous thrombosis, PE, peripheral arterial embolism ... 

Prophylaxis and treatment Prophylaxis and treatment of venous thrombosis and its extension pulmonary embolism peripheral arterial embolism atrial fibrillation with embolization. 

Treatment of venous thrombosis, pulmonary embolism, peripheral arterial embolism, atrial fibrillation with embolism Intermittently Initially, 10,000 units, then 50-70 units/kg (5000-10,000 units) q4 6h. IV Infusion Loading dose 80 units/kg, then 18 units/kg/hr, with adjustments based on aPTT. Range 10-30 units/kg/hr. 

It is indicated in the prophylaxis and treatment of deep vein thrombosis in major surgery and pulmonary embolism, treatment of atrial fibrillation with embolisation, prophylaxis and treatment of peripheral arterial embolism. 

Ouriel K, Kaul AF, Leonard MC. Clinical and economic outcomes in thrombolytic treatment of peripheral arterial occlusive disease and deep venous thrombosis. J Vase Surg. 2004 40 971-977. 

Urokinase is intended for intravenous use only and indicated for the treatment of pulmonary embolism, coronary artery thrombosis, and intravenous catheter clearance. Typical dosages in peripheral arterial disease consist of an infusion at a rate ranging from 60,000 lU/hr to 240,000 lU/hr infused directly into the thrombus. 

Early experience with this lytic in the treatment of peripheral arterial disease has been promising with equivalent safety and efficacy to alteplase (3 1,32). Burkart et al. published their initial experience in 13 patients with arterial occlusion and five with venous thrombosis. TNK-tPAwas administered at a rate of 0,25 mg/hr with restoration of flow in all patients, The clinical success with respect to limb salvage or symptom relief was achieved in I I of 13 (85%) patients and four out of the five patients with venous thrombosis, There were no intracranial bleeding complications,... 

Abciximab is used for prevention of cardiac ischemic events in patients undergoing percutaneous coronary intervention and to prevent myocardial infarction in patients with unstable angina who do not respond to conventional treatment. It has also been used for thrombolysis in patients with peripheral arterial occlusive disease and arterial thrombosis (2). 

The incidence of hemorrhagic complications is particularly high when high doses of streptokinase are used in the treatment of deep venous thrombosis (31). High-dose streptokinase thrombolysis for 2-3 days with an initial dose of 500 000 units followed by a maintenance dose of 3 600 000 U/day led to a 10% rate of major spontaneous bleeding complications, with a fatal outcome in four older subjects out of the total of 98 patients. The fatahty rate of bleeding caused by streptokinase amounts to 7% in patients with peripheral arterial occlusion, but is much lower in younger patients with venous thromboembolism. 

Clinical indications Prophylaxis and treatment of venous thrombosis PE peripheral arterial embolto AF Prevention of DVT and other thromboembolic complications treatment of acute DVT with or without PE Prophylaxis and treatment of venous thrombosis and its extension PE and thromboembolic complications associated with AF... 

Heparin is an anticoagulant that inhibits reactions that lead to clotting. It is indicated in prophylaxis and treatment of venous thrombosis and its extensions, pulmonary embolism (PE), peripheral arterial embolism, and atrial fibrillation with embolization diagnosis and treatment of acute and chronic consumption coagulopathies (DIC) and prevention of postoperative deep venous thrombosis. 

The number of percutaneous femoral arterial catheterizations has increased exponentially in recent years with several million procedures performed worldwide annually. A direct consequence of that explosion in number of percutaneous diagnostic and interventional catheterizations is the increasing number of vascular complications due to the percutaneous creation of that vascular access mainly using the femoral artery. Potential complications are pseudoaneurysm, arteriovenous fistula, uncontrollable groin and/or retroperitoneal bleeding, in situ arterial thrombosis, and peripheral embolization. In order to deal with these complications, there is an increasing need for quick and optimal diagnosis and for efficient and, by preference, minimally invasive treatment. 

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