Effect of continuous pulse injection of urokinase on thrombosis of arteriovenous fistulas

Abstract

Objective To investigate the curative effect and safety of continuous pulse injection of urokinase for the treatment of arteriovenous internal fistula thrombosis. Methods During the period from Jan. 2011 to Dec. 2014, 40 patients with arteriovenous internal fistula thrombosis were collected. They were randomly assigned to the improved group (continuous pulse urokinase injection) and control group (traditional urokinase application) according to the table of random digit. Thrombin time, prothrombin time, D-dimer, fibrinogen, hemoglobin, platelet, lipid and colored doppler ultrasonography of arteriovenous internal fistula before thrombolysis were recorded. All the patients used the 18 G venous indwelling needles. In the improved group, continuous pulse injection of urokinase (200 000 units) was performed. The same dose of urokinase were injected by micro-pump at the speed of 20 000 U/min in the control group. After that all the patients still received micro-pump injection of 300 000 units urokinase at the speed of 20 000 U/min, subcutaneous injection of low molecular heparin (4 000 U), intravenous injection of papaverine (30 mg), oral administration of aspirin (150 mg) for 3 days, respectively. We recorded the internal fistula recanalization, vital signs, bleeding, and the dose of urokinase every hour. The end points of our study were internal fistula recanalization, severe bleeding and pulmonary thromboembolism. The treatment could be repeated during the three days after admission. We compared the time and incidence of recanalization, dose of urokinase, incidence of bleeding and pulmonary thromboembolism between two groups. Results A total of 28 cases (93.33%) showed successful results in (30.33±27.23)hours an average, with (20 000±12 000)units urokinase in the improved group. Whereas, 22 cases (75.86%) showed successful results in an average of (50.15±22.18)hours, with (25 000±18 000)units urokinase in the control group. There was significant difference in the time and incidence of recanalization, dose of urokinase between two groups (P 0.05). Conclusions Compared to traditional urokinase application, continuous pulse urokinase injection achieves higher recanalization rate, shorter recanalization time, and less dose of urokinase. It does not increase the risk of bleeding as well. For the treatment of arteriovenous internal fistula thrombosis, continuous pulse urokinase injection is an effective and safe way, with great clinical value. Key words: Urinary plasminogen activator/TU; Injections, jet; Arteriovenous fistula/CO/DT; Thrombosis/CO/DT; Thrombolytic therapy