Catheter-directed thrombolytic therapy in peripheral XXXX : combining reteplase and abciximab.

@entity1 @entity932 @entity1410 @entity432 @entity715
OBJECTIVE: The goal of this study was to assess the safety and efficacy of combination therapy consisting of the third-generation plasminogen activator reteplase and the glycoproteins IIb and IIIa platelet receptor antagonist abciximab for thrombolysis in peripheral @entity432 . This two-center experience focused on immediate thrombolytic success, thrombolysis time, complication rate, and 30-day patency rate. SUBJECTS AND METHODS: Fifty @entity1 with @entity432 (age range, 40-96 years; mean age, 69 years) were prospectively enrolled at two centers. Eighteen @entity1 (36%) had native artery @entity715 , and 32 @entity1 (64%) had graft @entity715 . Catheter-directed intraarterial thrombolytic infusion of reteplase (average dose, 0.51 U/hr; range, 0.25-1 U/hr) was combined with IV infusion of abciximab (bolus, 0.25 mg/kg of body weight; 12-hr infusion, 0.125 microg/kg of body weight per minute). Nontherapeutic heparin (100-400 U/hr) was given intraarterially during the thrombolytic infusion. RESULTS: Complete thrombolysis was achieved in 89% of the @entity1 with native @entity432 and 94% of the @entity1 with graft occlusions for an overall rate of 92%. The average thrombolysis time was 20.7 hr (range, 4-41 hr) with a mean reteplase dose of 12.1 U (range, 2-23 U). Major @entity1410 occurred in 12% of the @entity1 , with an average blood transfusion of 3.1 U of packed RBC (range, 1-11 U), and correlated to increased thrombolysis time and dose. No @entity932 occurred. The 30-day primary patency rate was 92%. Two @entity1 (4%) underwent amputation, including one major amputation (2%), within 30 days of thrombolysis. CONCLUSION: The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. Results of this combination therapy suggest acceptable thrombolysis times and doses with tolerable complication rates. Which @entity1 group might benefit the most from combination therapy and the long-term results of combination therapy still need to be determined.
