Thrombolysis for peripheral arterial occlusions

Article Abstract:

Thrombolytic agents are drugs given to dissolve blood clots. They have been used for many years, but have had limited success in treating occlusions (blockages) in the peripheral arteries, which are located in the extremities. The treatments often take a long time and complications such as bleeding occur often. Efforts have been made to improve the performance of these drugs while decreasing their potential for causing side effects. Researchers have evaluated regional therapy, where the drug is infused at the site of the clot through a catheter. Initial work using this technique was not very successful, but more recent attempts using more aggressive drug applications have had greater success. Techniques have also been developed that expose more of the surface area of the clot to the medications. New drugs that are more effective and also safer have also been developed. Streptokinase was the first drug used for thrombolytic therapy. Urokinase has been shown to be more effective and to cause fewer side effects in recent studies. A new drug, tissue-type plasminogen activator (t-PA), has recently become available. It has been used in treating heart attacks for a few years and now has become available for treating peripheral arterial occlusions. Few studies have been done on the effectiveness of t-PA for this purpose. There have been high hopes that it would not have the side effects that are seen with streptokinase and urokinase. In the April 1990 issue of Radiology, a study by Meyerovitz and colleagues compared t-PA with urokinase in treating peripheral arterial occlusions. Although results indicated that t-PA was more effective, bleeding was also more common with this drug. These results are not conclusive, and whether t-PA is a better thrombolytic agent than those drugs previously available remains to be seen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Peripheral vascular diseases, editorial

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Risk management issues related to the use of contrast agents

Article Abstract:

Since 1985, several new contrast agents that are used to better view soft tissue during radiologic exams have become available. Debate is ongoing whether these new agents are safer than the old ones, and what kind of legal problems may arise from their use. A total of 2,100 malpractice claims submitted to one insurance company over an 11-year period were examined for claims involving radiologists. One hundred cases involved radiologists, and 10 of these involved the use of contrast media; these 10 cases are evaluated and discussed. Two of the claims related to the death of a patient; one death was found to result from the inherent toxicity of a contrast agent (this product has since been removed from the market); the other case involved a patient who had a previous reaction to contrast media, which was not noted by his physicians. Both of these claims were settled before trial. Two other cases were also settled out of court, and the remaining six were dropped or decided in favor of the physician. One of the settlements involved a woman who suffered a stroke because air, which had not been cleared from the injector, was infused into the patient's left ventricle. The other case involved a young boy who required a skin graft to his forearm after a skin sloughing reaction occurred; the contrast media almost completely leaked out of the vessel into the surrounding tissue when the physician and technician were out of the room. In general, there are very few incidents related to the use of contrast media, and most incidents that do occur do not involve toxicity, but some aspect of negligence in treatment protocol. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Risk management, Medical malpractice, Contrast media, Contrast media (Chemicals), Radiologists

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Recombinant tissue-type plasminogen activator versus urokinase in peripheral arterial and graft occlusions: a randomized trial

Article Abstract:

Drug therapy for treating occlusions (blockages) in peripheral arteries and veins (located in the limbs) that have been grafted has been in use for a number of years. These drugs, called fibrinolytic agents, work by breaking up blood clots that are causing the occlusions. Initially, streptokinase was used for this purpose. It was found to be very slow in breaking up the clots and caused a number of side effects. Advancements have led to the use of urokinase, infused at the site of the clot, for treating these conditions. The speed in dissolving the clots greatly improved, and side effects were decreased using this method. A newer drug, recombinant human tissue-type plasminogen activator (rt-PA), has been reported to dissolve the clots faster than urokinase, and it may possibly cause fewer side effects. This study compared the effectiveness and the side effects of the two drugs. Half of a group of 32 people suffering from arterial or graft occlusions took urokinase and the other half took rt-PA to treat the occlusions. Results showed that initially, rt-PA worked slightly faster is dissolving the clots. After 24 hours, eight of the 16 subjects receiving rt-PA and six of 16 receiving urokinase had achieved 95 percent lysis (dissolution) of their clots. In five subjects receiving rt-PA and in two receiving urokinase, major bleeding occurred as a side effect. Final outcomes were similar with the two treatments. These results indicate that although rt-PA may result in slightly more rapid lysis, it may also cause more side effects. (Consumer Summary produced by Reliance Medical Information, Inc.)

Arterial occlusions, Arterial occlusive diseases

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