Clinical Comparative Study Of Fibrinolytic Enzyme And Urokinase In The Treatment Of Patients With Acute Deep Vein Thrombosis Of Lower Limbs

Background:Acute deep venous thrombosis of lower limbs is a kind of common disease in angiology with high rate of occurrence and severe complication, these complication include pulmonary embolism,reocclusion and post thrombotic syndrome which led to leg's swelling,ulceration and disability. Only with the advent of unfractionated heparin a dramatic improvement occurred lowering the death rate , Later on, the introduction of coumarins as follow-up treatment led to a relatively safe long-term result with regard to rethrombosis and fatal pulmonary embolism and the use of low molecular weight heparin avoid continual laboratory test. however, the goal of anticoagulation drug is to inhibit further progress of thrombi, not to remove them, further more, they have relatively lower clearance of thrombosis comparing with fibrinolytic therapy.however Systemic fibrinolysis with streptokinase,urokinase and rt-PA infusions had only a limited clearance rate and was afflicted with some rate of bleeding. So we still face the problem of finding and evaluating a new fibrinolytic drug with high rate of clearance and lower rate of bleeding.Objective:The purpose of this article is to observe the recent clinical therapy and main adverse reaction of fibrinolytic enzyme and urokinase in the patients with acute deep vein thrombosis of lower limbs;Materials and Methods:From 2007.4 to 2008.11,fifty four patients hospitalized in common surgery and other relevant unit with ADVT were randomly divided into two groups with 27 patients in each group . Patients in these two groups were respectively treated by fibrinolytic enzyme ( 200IU ) for 15 days ,by urokinase ( 50 MU ) for first 3 days and UK(25MU)for another 10 days .Anticoagulant and antiplatelet drugs were used at the same time. Clinical efficacy and the complication of bleeding,hypersensitivity and pulmonary embolism were evaluated .Main observation indexes:Clearance of venous thrombosis was tested by colored doppler flow imaging, diameter of CFV,SFV and POV was tested by 2DUS after and before therapy; lever of D-dimer was tested on the 1,5,10day together with the day of before and after therapy. The complication of bleeding,hypersensitivity and pulmonary embolism were also evaluated .Result:Result of observation by CDFI: 42.9% of complete clearance and 46.4% of partial clearance were acquired by . fibrinolytic enzyme,46.4% of complete clearance and 31.0% of partial clearance were acquired by UK. there were no significant difference between two groups Result of observation by 2DUS: there were no significant difference in the diameter of CFV SFV and POV between two groups.There were no significant difference in the lever of D-D on the 5,10 day together with the days of before and after therapy between two group, the lever of D-D in the group of fibrinolytic enzyme was significantly higher than that of group urokinase .There was no significant difference in the rate hemorrhage and pulmonary embolism between two groups, the rate of bleeding and lower lever of fibrinolytic were significantly higher than that of group of urokinase.Conclusion:Both fibrinolytic enzyme and urokinase were effective , reliable thrombolytic drugs in the treatment of ADVT,. However , fibrinolytic enzyme showed significantly better security than that of urokinase in thrombolytic therapy.