Abstract
Our objective is to review important and recent clinical trials of systemic and local thrombolysis for acute venous thromboembolism (VTE). While anticoagulation is the cornerstone of VTE treatment, systemic thrombolysis is recommended for the highest risk pulmonary embolism (PE) patients who present with hypotension and also have a low bleeding risk. Utilization of low-dose, catheter-directed thrombolytic administration with or without ultrasound energy may minimize bleeding risk beyond systemic thrombolysis. Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a common cardiovascular disease. Current guidelines recommend anticoagulation over catheter-directed thrombolysis in acute DVT primarily due to the limitations of available data. Clinical trial information is conflicting on whether catheter-directed thrombolysis reduces rates of post-thrombotic syndrome and improves rates of vessel patency. Stability data on alteplase in the catheter-directed setting are limited. Our mass spectrometry analysis indicates that a wide range of alteplase concentrations are stable for at least 24 h. These data can reassure pharmacists, nurses, and physicians that alteplase remains stable during infusion durations utilized in catheter-directed thrombolysis. Individual facilities can tailor their alteplase preparation to meet their own institutional needs.
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