Venous thrombolysis in the post-urokinase era

Abstract

Catheter-directed thrombolysis is emerging as an alternative to standard anticoagulation for management of extensive symptomatic deep vein thrombosis (DVT) of the upper and lower extremities. Urokinase, a first-generation plasminogen activator, has been the thrombolytic agent of choice for the past 2 decades. However, in early 1999, the Food and Drug Administration (FDA) suspended sales of urokinase in the United States. The unavailability of urokinase has forced practitioners to search for suitable alternative agents for catheter-directed therapy. Unfortunately, few US interventionalists have any practical experience in using alternative plasminogen activators for managing noncoronary thromboses. The purpose of this article is to review emerging newer antithrombotic agents including alternative agents to urokinase, propose a protocol for catheter-directed therapy for deep vein thrombosis, and highlight the role of stents in the endovascular management of venous disease. Catheter-directed thrombolysis is emerging as an alternative to standard anticoagulation for management of extensive symptomatic deep vein thrombosis (DVT) of the upper and lower extremities. Urokinase, a first-generation plasminogen activator, has been the thrombolytic agent of choice for the past 2 decades. However, in early 1999, the Food and Drug Administration (FDA) suspended sales of urokinase in the United States. The unavailability of urokinase has forced practitioners to search for suitable alternative agents for catheter-directed therapy. Unfortunately, few US interventionalists have any practical experience in using alternative plasminogen activators for managing noncoronary thromboses. The purpose of this article is to review emerging newer antithrombotic agents including alternative agents to urokinase, propose a protocol for catheter-directed therapy for deep vein thrombosis, and highlight the role of stents in the endovascular management of venous disease.