Alteplase Least Expensive for Thrombolysis of Deep Vein Thrombosis

Laurie Barclay, MD

April 15, 2004

April 15, 2004 -- Alteplase (tissue plasminogen activator; TPA) is the least expensive thrombolytic therapy for deep vein thrombosis (DVT), according to the results of a retrospective review published in the April issue of the Journal of Vascular and Interventional Radiology. Urokinase (UK), TPA, and reteplase (RPA) were equally efficacious and safe for catheter-directed thrombolysis, with no reported intracranial hemorrhage, but TPA was much less expensive.

"Continued comparison of TPA and UK with RPA has been rendered increasingly relevant by the return of UK to the US market in October 2002," write Michael R. Grunwald, AB, and Lawrence V. Hofmann, MD, from The Johns Hopkins School of Medicine in Baltimore, Maryland. "This study was undertaken to compare the efficacy, safety, and pharmacoeconomics of UK, TPA, and RPA."

Of 74 patients with 82 involved limbs treated using catheter-directed thrombolysis, 27 were men and 47 were women. UK with therapeutic heparin was used in 38 limbs, TPA with subtherapeutic heparin dosing was used in 32 limbs, and RPA with subtherapeutic heparin dosing was used in 12 limbs. The three groups were similar in sex and age distribution, disease location, duration of symptoms, and use of additional interventional therapies.

Success rate for thrombolysis was 97.4% to 100%, and it did not differ statistically among groups. Infusion times and complications were also similar among the three groups, and none of the patients developed intracranial hemorrhage. However, TPA was 13 times less expensive than UK ( P < .001) and four times less expensive than RPA ( P < .01). Drug costs were $488 for TPA, $1,787 for RPA, and $6,577 for UK.

Study limitations include small sample size, retrospective design, sequential data collection, and use of RPA in only 12 patients. The authors therefore recommend confirmation of these findings in a randomized, prospective, multicenter trial.

"Catheter-directed thrombolysis for the treatment of DVT is safe and effective, regardless of the agent used," the authors write. "However, the new recombinant agents are significantly less expensive than urokinase."

Dr. Hofmann is a paid member of the speakers bureau for Genentech, the maker of alteplase.

J Vasc Interv Radiol. 2004;15:347-352

Reviewed by Gary D. Vogin, MD

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