Catheter-directed Thrombolytic Therapy For The Treatment Of Acute Iliofemoral Venous Thrombosis With Use Of Alteplase And Urokinase:a Comparative Clinical Study

Objective:Acute deep venous thrombosis(ADVT)is a common disease of vascular surgery.The acute period of the central type,that is the acute iliac femoral venous thrombosis(IFVT),is vulnerable to life-threatening pulmonary embolism(PE).Catheter-directed thrombolysis(CDT),which significantly improves the efficacy of thrombolytic drugs and shortens the time of administration,is becoming increasingly widespread in clinical application.At present,The most commonly used thrombolytic drug in China is urokinase(UK).Alteplase(rt-pa),the second generation of thrombolytic drugs,has been widely used in acute myocardial infarction,acute cerebral infarction,and acute pulmonary embolism.In recent years,a large number of foreign studies have confirmed that alteplase is also a safe and effective thrombolytic drug of acute DVT,and there has been few domestic reports.In this paper,we conducted a case-control study on the efficacy and safety between alteplase and urokinase in the treatment of acute IFVT by CDT).Methods:A total of 103 cases of acute IFVT proved by venography were identified from January 2015 to October 2016 at the Department of Intervention of NanJing first hospital.All patients were divided into two groups.In group A,36 patients were treated by CDT with rt-PA.In group B,67 patients were treated by CDT with urokinase.All cases were implanted the inferior vena cava filter(IVCF)before the CDT treatment to prevent the occurrence of fatal pulmonary embolism in the thrombolytic process.Additional anticoagulants were employed at the same time.Clinical observation indicators included rate of edema reduction and venous patency.According to the clinical symptoms and the final follow-up venograms,the effect of thrombolysis was divided into three levels:effective,partially effective and ineffective.The total effective rate=(the number of effective cases + the number of partially effective cases)/the number of the total caces X 100%.At the same time,the infusion time and the complications of hemorrhage were recorded.The differences of edema reduction rate,venous patency and infusion time between the two groups before and after treatment were compared by independent t test.The therapeutic effective rate and hemorrhage complication rate were assessed using Chi-square test.Results:The total effective rates of group A(rt-PA)and group B(UK)were 94.4%and 92.5%respectively.The limbs edema reduction rate were(89.2±11.5)%and(88.3±9.9)%respectively.The venous patency after thrombolysis were(67.8±23.4)%and(60.0±21.4)%respectively.The bleeding rates were:group A,13.8%(5/36)and group B,11.9%(8/67)respectively.The infusion time was as follows:group A,4.2±1.3d and group B,6.6±2.1d.There was no significant difference between group A and group B in total effective rates(x =0.134,P=0.714),limbs edema reduction rate(F=0.894,P=0.676),the venous patency after thrombolysis(F=0.194,P=0.860)and the bleeding rate(x2=0.081,P=0.776).However,rt-PA was significantly faster than UK(F=9.169,P=0.003).Conclusion:Treatment of acute IFVT by CDT with alteplase has a high safety and satisfactory clinical effect.Compared with urokinase,rt-PA can significantly reduce infusion time.For the need to minimize the infusion time of the patients,alteplase can be preferred to use.