Which are the most effective fibrinolytic agents for peripheral arterial occlusion?
There was some evidence to suggest intra-arterial (IA) recombinant
tissue plasminogen activator (rt-PA) was more effective
than IA streptokinase or intravenous (IV) rt-PA in improving vessel
patency in people with peripheral arterial occlusion (PAO). There
was no evidence IA rt-PA was more effective than IA urokinase for
patients with PAO. There was some evidence initial lysis may be
more rapid with rt-PA, depending on the regimen. The incidence
of haemorrhagic complications varied with fibrinolytic regimen but
there were no statistically significant differences between IA urokinase
and IA rt-PA. IV rt-PA and IA streptokinase were associated
with a significantly higher risk of haemorrhagic complications than
IA rt-PA. The drugs investigated were streptokinase, urokinase,
rt-PA and pro-urokinase.
No particular drug was more effective in preventing limb loss or
death than another. All of the findings came from small studies,
and the general paucity of results means it is not possible to
draw clear conclusions.
Peripheral arterial thrombolysis is used in the management of peripheral
arterial ischaemia. Streptokinase was originally used but
safety concerns have led to the introduction of other agents such
as urokinase and rt-PA. These newer agents were thought to have
potential advantages, such as improved safety, greater efficacy,
and a more rapid response.