Alteplase as an Alternative to Urokinase

Abstract

For the past 20 years, urokinase (UK) has been the primary agent used in the United States for catheter-directed thrombolytic therapy of acute limb ischemia and deep vein thrombosis (DVT), and for restoration of patency in hemodialysis access and clotted intravenous access devices ( 1 Ouriel K Surgery versus thrombolytic therapy in the management of peripheral arterial occlusions. JVIR. 1995; 6: 48S-54S Abstract Full Text PDF Scopus (16) Google Scholar , 2 Semba CP Dake MD Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology. 1994; 191: 487-494 PubMed Google Scholar , 3 Bookstein JJ Fellmeth B Roberts A Valji K Davis G Machado T Pulse-spray pharmacomechanical thrombolysis: preliminary clinical results. Am J Radiol. 1989; 152: 1097-1100 Google Scholar , 4 Haire WD Atkinson JB Stephens LC Kotulak GD Urokinase versus recombinant tissue plasminogen activator in thrombosed central venous catheters: a double-blinded, randomized trial. Thromb Haemost. 1994; 72: 543-547 PubMed Google Scholar ). However, in 1999, the Food and Drug Administration suspended the sales and distribution of UK (Abbokinase; Abbott Laboratories, Abbott Park, IL) in the United States ( 5 Center for Biologics Evaluation and Research, Public Health Service Important Drug Warning: Dear Healthcare Provider. Available online at. http://www.fda.gov/cber/ltr/abb012599.html Google Scholar ). Unfortunately, few American interventionalists had previous experience in the use of alternative agents to UK. To address this urgent clinical crisis, a multidisciplinary Advisory Panel on Catheter-Directed Thrombolytic Therapy consisting of vascular specialists was organized by the Society of Cardiovascular and Interventional Radiology (SCVIR) and convened in New York, NY, on August 9, 1999, to develop preliminary recommendations for the benefit of SCVIR members. The goal of the advisory panel was to: (i) identify alternative plasminogen activators; (ii) review the published literature on alternative plasminogen activators; (iii) review the multidisciplinary advisory panel experience with the use of alternative agents; and (iv) develop preliminary clinical guidelines for managing acute limb ischemia, DVT, thrombosed dialysis grafts, and clotted intravascular catheters and ports. This document is a summary of the Advisory Panel meeting and is intended for the establishment of guidelines in the use of alternative agents to UK in clinical practice. The meeting was supported by an unrestricted educational grant from Genentech, Inc. (South San Francisco, CA) and sponsored by the SCVIR.