Initial experience with the combination of reteplase and abciximab for thrombolytic therapy in peripheral arterial occlusive disease: a pilot study.

Abstract

PURPOSE:

To report the efficacy of catheter-directed thrombolysis with a combination of a thrombolytic agent (reteplase) and a glycoprotein (GP) IIb/IIIa platelet receptor antagonist (abciximab) in peripheral arterial occlusive disease.

MATERIALS AND METHODS:

Fifteen patients with lower extremity arterial thromboses (age range, 40-96 y; mean, 73 y) were prospectively enrolled in a protocol approved by the Institutional Review Committee. Nine patients had native arterial occlusions, three (33%) of whom had subacute symptoms (>14 d) and one of whom had chronic symptoms (>3 mo). Four patients had acute arterial graft thromboses. Two patients with lower extremity bypass grafts presented with subacute limb ischemia. All patients received catheter-directed infusion of reteplase (0.5 U/h) in combination with intravenous administration of abciximab (0.25-mg/kg bolus followed by 0.125 microg/kg/min infusion) for 12 hours without systemic heparinization. The thrombolytic success was studied by Doppler ultrasonography (US) and angiography.

RESULTS:

Complete thrombolysis and clinical success was achieved in 14 of the 15 patients (93%). One patient with unsuccessful thrombolysis underwent major amputation. The mean thrombolysis time per Doppler US procedure was 6.8 hours (range, 2-30 h). Angiographic patency was achieved at a mean of 17.5 hours (range, 4-36 h) corresponding to a mean dose of reteplase of 8.8 U. The mean increase in ankle-brachial index was 0.52 (range, 0-0.9). No major hemorrhagic complications occurred. The 30-day primary patency rate was 93%.

CONCLUSION:

The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. This combination therapy pilot study suggests short thrombolysis times and minimal adverse effects in catheter-directed thrombolytic therapy for peripheral arterial occlusive disease.

• Authors: Peter Drescher, Martin R Crain, William S Rilling
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 13 Issue 1 Pg. 37-43 (Jan 2002) ISSN: 1051-0443 [Print] United States
• PMID: 11788692 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Antibodies, Monoclonal
• Fibrinolytic Agents
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Recombinant Proteins
• reteplase
• Tissue Plasminogen Activator
• Abciximab

Topics

• Abciximab
• Adult
• Aged
• Aged, 80 and over
• Antibodies, Monoclonal (adverse effects, therapeutic use)
• Arterial Occlusive Diseases (drug therapy)
• Drug Therapy, Combination
• Female
• Femoral Artery
• Fibrinolytic Agents (adverse effects, therapeutic use)
• Graft Occlusion, Vascular (drug therapy)
• Humans
• Immunoglobulin Fab Fragments (adverse effects, therapeutic use)
• Male
• Middle Aged
• Pilot Projects
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Popliteal Artery
• Prospective Studies
• Recombinant Proteins (adverse effects, therapeutic use)
• Tissue Plasminogen Activator (adverse effects, therapeutic use)
• Treatment Outcome
• Ultrasonography, Doppler