Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis

Richard Chang, McDonald K. Horne, Thomas H. Shawker, Anthony W. Kam, Enn Alexandria Chen, Galen O. Joe, Willie L. Ching, Edie Mao, David A. Wyrick, Jay N. Lozier

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the safety and efficacy of once-daily intraclot injections of low doses (≤ 10 mg) of tissue plasminogen activator (tPA) for thrombolysis of venous thrombosis. Materials and Methods: In prospective studies, 33 patients with subclavian, jugular, and central venous thrombosis (SJ-CVT) (all but two cases associated with central catheters) were treated once a day with ≤ 4 mg/day of tPA, and 30 patients with acute deep vein thrombosis of the lower extremity (DVT-LE) <14 days old were treated once a day with ≤ 10 mg/leg/day of tPA by intraclot "lacing" of thrombus without continuous infusions of tPA. Results: Patency was restored in 26 (79%) of 33 patients with SJ-CVT using an average total dose of 7.1 mg of tPA/per patient and average of 2.1 treatments or days of therapy. Five patients received thrombolytic therapy for SJ-CVT as outpatients. Initial patency was restored in 29 (97%) of 30 patients with acute DVT-LE using an average total dose of 20 mg of tPA per patient over an average of 2.7 treatments/or days per patient. Follow-up imaging examinations at 6 months showed continued patency in 27 (96%)/of 28 patients. There were no major bleeding complications, and no patient required a blood transfusion. Conclusions: Intraclot injection of low doses of alteplase is effective for acute venous thrombosis, and pharmacokinetic data suggest potentially greater safety.

Original languageEnglish (US)
Pages (from-to)1107-1116
Number of pages10
JournalJournal of Vascular and Interventional Radiology
Volume22
Issue number8
DOIs
StatePublished - Aug 2011

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Tissue Plasminogen Activator
Venous Thrombosis
Injections
Therapeutics
Neck
Lower Extremity
Safety
Thrombolytic Therapy
Blood Transfusion
Leg
Thrombosis
Outpatients
Catheters
Pharmacokinetics
Prospective Studies
Hemorrhage

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis. / Chang, Richard; Horne, McDonald K.; Shawker, Thomas H.; Kam, Anthony W.; Chen, Enn Alexandria; Joe, Galen O.; Ching, Willie L.; Mao, Edie; Wyrick, David A.; Lozier, Jay N.

In: Journal of Vascular and Interventional Radiology, Vol. 22, No. 8, 08.2011, p. 1107-1116.

Research output: Contribution to journalArticle

Chang, R, Horne, MK, Shawker, TH, Kam, AW, Chen, EA, Joe, GO, Ching, WL, Mao, E, Wyrick, DA & Lozier, JN 2011, 'Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis', Journal of Vascular and Interventional Radiology, vol. 22, no. 8, pp. 1107-1116. https://doi.org/10.1016/j.jvir.2011.03.023
Chang, Richard ; Horne, McDonald K. ; Shawker, Thomas H. ; Kam, Anthony W. ; Chen, Enn Alexandria ; Joe, Galen O. ; Ching, Willie L. ; Mao, Edie ; Wyrick, David A. ; Lozier, Jay N. / Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis. In: Journal of Vascular and Interventional Radiology. 2011 ; Vol. 22, No. 8. pp. 1107-1116.
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AU - Chang, Richard

AU - Horne, McDonald K.

AU - Shawker, Thomas H.

AU - Kam, Anthony W.

AU - Chen, Enn Alexandria

AU - Joe, Galen O.

AU - Ching, Willie L.

AU - Mao, Edie

AU - Wyrick, David A.

AU - Lozier, Jay N.

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N2 - Purpose: To evaluate the safety and efficacy of once-daily intraclot injections of low doses (≤ 10 mg) of tissue plasminogen activator (tPA) for thrombolysis of venous thrombosis. Materials and Methods: In prospective studies, 33 patients with subclavian, jugular, and central venous thrombosis (SJ-CVT) (all but two cases associated with central catheters) were treated once a day with ≤ 4 mg/day of tPA, and 30 patients with acute deep vein thrombosis of the lower extremity (DVT-LE) <14 days old were treated once a day with ≤ 10 mg/leg/day of tPA by intraclot "lacing" of thrombus without continuous infusions of tPA. Results: Patency was restored in 26 (79%) of 33 patients with SJ-CVT using an average total dose of 7.1 mg of tPA/per patient and average of 2.1 treatments or days of therapy. Five patients received thrombolytic therapy for SJ-CVT as outpatients. Initial patency was restored in 29 (97%) of 30 patients with acute DVT-LE using an average total dose of 20 mg of tPA per patient over an average of 2.7 treatments/or days per patient. Follow-up imaging examinations at 6 months showed continued patency in 27 (96%)/of 28 patients. There were no major bleeding complications, and no patient required a blood transfusion. Conclusions: Intraclot injection of low doses of alteplase is effective for acute venous thrombosis, and pharmacokinetic data suggest potentially greater safety.

AB - Purpose: To evaluate the safety and efficacy of once-daily intraclot injections of low doses (≤ 10 mg) of tissue plasminogen activator (tPA) for thrombolysis of venous thrombosis. Materials and Methods: In prospective studies, 33 patients with subclavian, jugular, and central venous thrombosis (SJ-CVT) (all but two cases associated with central catheters) were treated once a day with ≤ 4 mg/day of tPA, and 30 patients with acute deep vein thrombosis of the lower extremity (DVT-LE) <14 days old were treated once a day with ≤ 10 mg/leg/day of tPA by intraclot "lacing" of thrombus without continuous infusions of tPA. Results: Patency was restored in 26 (79%) of 33 patients with SJ-CVT using an average total dose of 7.1 mg of tPA/per patient and average of 2.1 treatments or days of therapy. Five patients received thrombolytic therapy for SJ-CVT as outpatients. Initial patency was restored in 29 (97%) of 30 patients with acute DVT-LE using an average total dose of 20 mg of tPA per patient over an average of 2.7 treatments/or days per patient. Follow-up imaging examinations at 6 months showed continued patency in 27 (96%)/of 28 patients. There were no major bleeding complications, and no patient required a blood transfusion. Conclusions: Intraclot injection of low doses of alteplase is effective for acute venous thrombosis, and pharmacokinetic data suggest potentially greater safety.

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