Thrombolytic therapy.

P F Lawrence; G R Goodman

doi:10.1016/s0039-6109(16)45784-1

Home/Archive/PubMed

PubMed · 1496443

Thrombolytic therapy.

P F Lawrence·G R Goodman

View original source ↗Export metadata ↓

Abstract

Thrombolytic therapy may be used as either sole treatment or an adjunct to surgery in both arterial and venous disease. The age of the clot, particularly with venous thrombosis, determines the probability of successful lysis, with recent clot being highly susceptible to lytic therapy. The technique of thrombolysis is also an important determinant of the outcome, with high doses delivered directly into the clot over short time periods associated with the highest success and the lowest complication rates. Because systemic therapy increases the risk of bleeding from a remote site, techniques to concentrate the lytic agent within the clot, such as intraoperative high-dose and isolated-limb therapy, may achieve a higher success with a lower complication rate. Newer agents, which are clot specific, will be available for lytic therapy and should result in even higher success rates while minimizing systemic complications.

Explore related subjects

Fibrinolytic Agents Humans Peripheral Vascular Diseases Thrombolytic Therapy Journal Article Review

Keep this discovery

Explore connections, maps & timelines

BibTeX RIS

P F Lawrence, G R Goodman. 1992. Thrombolytic therapy.. https://doi.org/10.1016/s0039-6109(16)45784-1

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2004

Update on the prevention of venous thromboembolism.

PURPOSE: The risk factors for venous thromboembolism (VTE), recommendations for risk stratification and prophylaxis of VTE based on risk, nonpharmacologic and pharmacologic interventions used for prophylaxis, and clinical controversies surrounding VTE prophylaxis are discussed. SUMMARY: Risk factors for VTE are common in hospitalized patients and readily identifiable in patients' medical history. The recommended prophylactic strategy depends on the degree of risk. Nonpharmacologic interventions may suffice for patients at low risk for VTE, but antithrombotic drug therapy is recommended for patients at moderate or higher risk. Newer antithrombotic agents with more specific activity on the coagulation cascade than older agents have been developed to improve on efficacy, safety, and convenience. Current recommendations of the American College of Chest Physicians (ACCP) do not reflect the availability of the newest agents; these agents are likely to be included as options for patients at the highest risk for VTE when ACCP updates its recommendations in the near future. CONCLUSION: The optimal agent, timing of initiation, and duration of prophylaxis in patients at the highest risk for VTE are ongoing controversies.

Fibrinolytic Agents↗

PubMed2004

[Summary of the practice guideline 'Peripheral vascular disease' (first revision) from the Dutch College of General Practitioners].

Peripheral vascular disease is a manifestation of atherosclerosis and may occur with or without signs or symptoms. The local prognosis is worse with signs or symptoms. The concomitant atherosclerosis in heart and brain is responsible for long-term morbidity and mortality. Absence of signs and symptoms almost excludes peripheral vascular disease, but for the diagnosis an ankle-brachial index is mandatory. This implies a protocol in general practice. Treatment of peripheral vascular disease consists of advice on cardiovascular risk factors, stopping smoking, walking exercises, and foot care. For peripheral vascular disease, anti-thrombotic medication is advised.

Fibrinolytic Agents↗

PubMed2004

Benefits of antithrombotic therapy after infrainguinal bypass grafting: a meta-analysis.

PURPOSE: We performed a meta-analysis to ascertain the benefits of antithrombotic therapy for maintaining the patency of vascular grafts following lower extremity bypass operations. METHODS: We identified articles using MEDLINE and hand searches of relevant journals for randomized clinical trials that compared the use of antithrombotic therapy with control or placebo therapy. Random-effects (DerSimonian and Laird) analyses were used to determine the risk of graft occlusion following lower extremity bypass operations. We also assessed the odds of secondary outcomes, such as myocardial infarction, cerebrovascular accident, all-cause mortality, and bleeding. RESULTS: Sixteen articles met the inclusion criteria of a randomized trial of antithrombotic therapy for the patency of vascular grafts; six were excluded because the analyses involved repeat surgeries or lacked a control group. Of the 10 studies included in the final analysis, seven compared antiplatelet agents with placebo or control, and three compared anticoagulant agents with placebo or control. The 10 studies were homogeneous in spite of differing durations of follow-up. The odds of graft occlusion in the treated group was half that in the placebo or control group. The odds ratio was 0.46 (95% confidence interval [CI]: 0.32 to 0.66) for the 10 studies that reported outcomes at 12 months or longer, 0.50 (95% CI: 0.29 to 0.87) in the five studies with 12-month rates; and 0.58 (95% CI: 0.39 to 0.88) at 24 months. CONCLUSION: Antithrombotic therapy decreases the risk of graft occlusion after a vascular operation by about 50% at 12 months and is still protective at 24 months after the operation.

Fibrinolytic Agents↗