Safety of thrombolytic therapy with urokinase or recombinant tissue plasminogen activator for peripheral arterial occlusion: a comprehensive compilation of published work.

Abstract

PURPOSE:

To report a comprehensive literature review focused on comparing the risk of complications with urokinase versus recombinant tissue plasminogen activator (rtPA) for thrombolytic treatment of peripheral arterial occlusions.

METHODS:

The English-language literature between 1985 and 2002 was searched for studies that used tissue-derived urokinase or rtPA in the treatment of peripheral arterial occlusions. Forty-eight studies (22 urokinase, 22 rtPA, and 4 that included both treatments) were identified, encompassing 2226 urokinase-treated patients and 1927 rtPA-treated patients. The safety of each thrombolytic agent was assessed based on the incidence of major hemorrhage, intracerebral hemorrhage, major limb amputation, transfusions, and mortality.

RESULTS:

The review revealed a wide range of study protocols, patient conditions, ages of occlusions, dosages/delivery methods of lytic agents, and criteria for reporting complications. The incidence of major hemorrhage varied widely, but the overall rate was lower among urokinase-treated patients (6.2%) than for patients treated with rtPA (8.4%, p=0.007). The overall incidence of intracerebral hemorrhage was also significantly lower for urokinase (0.4% versus 1.1% for rtPA, p=0.020). The major amputation rate was similar for both treatments (urokinase 7.9%, rtPA 7.2%), but the mortality rate was significantly lower for urokinase (3.0% versus 5.6% for rtPA, p<0.001). The need for transfusions was less frequent with urokinase (11.1% versus 16.1%, p=0.002).

CONCLUSIONS:

These results from a large body of published literature suggest that urokinase may be associated with a lower incidence of complications than rtPA in the treatment of peripheral arterial occlusions.

• Authors: Kenneth Ouriel, Krishna Kandarpa
• Journal: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists (J Endovasc Ther) Vol. 11 Issue 4 Pg. 436-46 (Aug 2004) ISSN: 1526-6028 [Print] United States
• PMID: 15298504 (Publication Type: Journal Article, Review)

Chemical References

• Plasminogen Activators
• Tissue Plasminogen Activator
• Urokinase-Type Plasminogen Activator

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Arterial Occlusive Diseases (drug therapy)
• Child
• Child, Preschool
• Female
• Humans
• Infant
• Male
• Middle Aged
• Peripheral Vascular Diseases (drug therapy)
• Plasminogen Activators (administration & dosage, adverse effects)
• Thrombolytic Therapy (adverse effects)
• Tissue Plasminogen Activator (administration & dosage, adverse effects)
• Urokinase-Type Plasminogen Activator (administration & dosage, adverse effects)