INTRA-ARTERIAL UROKINASE INFUSION IN ACUTE ARTERIAL OCCLUSION OF THE LIMBS

Abstract

20 patients with acute arterial occlusion of the limbs have been treated with a continuous urokinase (UK) infusion through an intra-arterial catheter placed as close as possible to the occlusion. A loading dose of 4400 IU/Kg was given over a period of 15 minutes. Subsequently an infusion of 4400 IU/Kg per hour was administered during the following 12 hours. Blood samples were drawn pre- and post-therapy to see the state of coagulation and fibrinolysis, including α2-antiplasmin (α2-AP), plasminogen (PLG) (chromogenic methods) and fibrinogen degradation products (FDP) (Merskey) determinations.RESULTS: There was a mild decrease of the plasma fibrinogen level from 306 ± 75 mg/lOOml previous to treatment to 195 ± 64 mg/lOOml post UK infusion and the FDP raised up to 330 ± 274 μg/ml. After terminating the UK infusion, Thrombin time ratio was 1.8 ± 0.5 and Reptilase time ratio was 2.0 ± 0.9. α2-AP activity was near 0 % in all cases and PLG fell to 33.7 ± 14.4 % of its initial concentration. Factor V activity was 63.6±19.9 %. In two out of three patients with severe ischaemia amputation was avoided. 17 patients suffered a less severe limb ischaemia. When the estimated occlusion time was less than 7 days a 60 % of complete lysis and a 20 % of partial lysis was obtained. In occlusions of more than a week the figures were 14 % and 28 % respectively. Bleeding around the insertion site of the catheter or local hematoma occurred in 5 cases.We conclude that intra-arterial infusion of UK in acute arterial ischaemia of the limbs is an effective treatment in occlusions of less than 7 days. According to our previous experience the bleeding risk seems to be less than during systemic or local streptokinase therapy.(All data are expressed as mean ± SD.)