What is the role of plasminogen activators in the percutaneous transcatheter treatment of deep venous thrombosis (DVT)?

Updated: Dec 10, 2019
  • Author: Donald Schreiber, MD, CM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Plasminogen activators include streptokinase, uPA, tissue-type plasminogen activator (tPA; alteplase), tenecteplase (TNK), and recombinant tPA (r-tPA; reteplase). The FDA has approved only streptokinase for systemic thrombolytic therapy of DVT. However, this agent is not currently recommended because of high rates of allergic reaction and bleeding complications and because of the availability of lower-risk agents. In the 1980s and 1990s, uPA was used extensively, but when it was temporarily taken off the market, tPA and r-tPA subsequently became the agents of choice.

In a retrospective analysis of catheter-directed thrombolysis for DVT, no significant differences were observed between uPA, tPA, and r-tPA with regard to success rate (>97%) or major complications (3-8%), although tPA and r-tPA were significantly less expensive than uPA. [16]

Recommended continuous dosages for catheter-directed thrombolysis of unilateral leg DVT are as follows:

  • tPA - 0.5-1.0 mg/h

  • r-tPA - 0.25-0.75 U/h

  • TNK - 0.25-0.5 mg/h

Other dosing options include an initial lacing dose, which entails an initial bolus given throughout the target thrombus, and a front-loaded dose, which is a high concentration given for the first few hours. No advantage to either approach has been demonstrated.


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