The safety, efficacy, and pharmacoeconomics of low-dose alteplase compared with urokinase for catheter-directed thrombolysis of arterial and venous occlusions

Koji Sugimoto, Lawrence V. Hofmann, Mahmood K. Razavi, Stephen T. Kee, Daniel Y. Sze, Michael D. Dake, Charles P. Semba

Research output: Contribution to journalArticle

75 Scopus citations

Abstract

Purpose: The purpose of this study was to compare the efficacy, complications, and costs associated with low-dose (≤2 mg/h) alteplase (tissue plasminogen activator [t-PA]) versus urokinase for the catheter-directed treatment of acute peripheral arterial occlusive disease (PAO) and deep vein thrombosis (DVT). Materials and methods: A retrospective review was performed during sequential time periods on two groups with involved extremities treated with either t-PA with subtherapeutic heparin (TPA group) or urokinase with full heparin (UK group) at a single center. Treatment group characteristics, success rates, complications, dosages, infusion time, and costs were compared. Results: Eighty-nine patients with 93 involved limbs underwent treatment (54 with DVT, 39 with PAO). The treatment groups were statistically identical (TPA: 45 limbs; 24 with DVT, 53.3%; 21 with PAO, 46.7%; UK: 48 limbs; 30 with DVT, 62.5%; 18 with PAO, 37.5%). The overall average hourly infused dose, total dose, infusion time, success rates, and cost of thrombolytic agent were as follows (± standard deviation): TPA, 0.86 ± 0.50 mg/h, 21.2 ± 15.1 mg, 24.6 ± 11.2 hours, 89.4%, $466 ± $331; and UK, 13.5 ± 5.6 (10 4 ) U/h, 4.485 ± 2.394 million U, 33.3 ± 13.3 hours, 85.7%, $6871 ± $3667, respectively. Major and minor complication rates were: TPA, 2.2% and 8.9%; and UK, 2.1% and 10.4%, respectively. No statistical differences in success rates or complications were observed; however, t-PA was significantly (P < .05) less expensive and faster than urokinase. Conclusion: Low-dose t-PA combined with subtherapeutic heparin is equally efficacious and safe compared with urokinase. Infusions with t-PA were significantly shorter and less expensive than those with urokinase.

Original languageEnglish (US)
Pages (from-to)512-517
Number of pages6
JournalJournal of vascular surgery
Volume37
Issue number3
DOIs
Publication statusPublished - Mar 1 2003
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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