Efficacy And Safety Of Two Different Doses Of Rt-PA Catheter-directed Thrombolysis For Lower Limb Ischemia:a Meta-analysis

Objective:To assess the efficacy and safety of low-dose (10 mg) and high-dose (20 mg) of recombinant tissue typeplasminogen activator (rt-PA) catheter-directed thrombolysis for lower limb ischemia by using meta-analysis.Methods:Computerized retrieval VIP (1990～2013), Cochrane Library, Springer Link (1990-2013), OVID (1990-2013), Pubmed (1990～2013), Science Direct (1990-2013), EBSCO (1990～2013), EMBASE (1990～2013) the literature of randomized clinical trials (RCT) concerning low- versus high-dose rt-PA catheter-directed thrombolysis for lower limb ischemia study were searched using the national and international electronic databases. The literatures were screened and quality evaluated according to the inclusion and exclusion criteria, and analyzed by using the Cochrane Center the RevMan 5.2 software.Results:A total of 4 RCT studies, with a total of 360 patients (192 patients in low dose group and 168 patients in high-dose group) were included. No statisticaldifference were noted in low-versus high-dose group with regard to ankle-brachial index (MD=0.20,95%CI=-0.43～0.02,P=0.07),30 days amputation-free survival(OR= 1.05, 95%CI=0.50～2.19, P=0.90),6 months the probability of restenosis (OR=1.00,95% CI=0.54～1.84,P=1.00),and the incidence of groin hematoma(<5 cm)(OR=126, 95%CI=0.54-2.96,P=0.59).But the incidence of bleeding and the incidence of stress ulcer in low-dose group were lower than those in high-dose group OR=2.58, 95%CI=1.11～5.98,P=0.03; OR=2.81,95%CI=1.25-6.31P=0.01). Conclusion:During This meta-analysis reveals ankle-brachial index,30 days amputation-free survival,6 months the probability of restenosis, two doses of rt-PA treatment of limb ischemia similar efficacy, but the incidence of low-dose regimen of complications issignificantly lower than the high dose regimen.