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中华介入放射学电子杂志 ›› 2017, Vol. 05 ›› Issue (04) : 282 -287. doi: 10.3877/cma.j.issn.2095-5782.2017.04.016

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综述

下肢深静脉血栓形成的溶栓治疗现状与尿激酶、阿替普酶的临床应用
公茂峰1, 陈国平1, 顾建平1,()   
  1. 1. 210006 南京医科大学附属南京医院(南京市第一医院)介入科
  • 收稿日期:2017-04-26 出版日期:2017-11-01
  • 通信作者: 顾建平
  • 基金资助:
    国家自然科学基金(81541061); 江苏省条件建设与民生科技专项专项资金(BL2014013); 南京市医学科技发展重点项目(ZKX15025)

Review of thrombolytic therapy for deep venous thrombosis and clinical application of urokinase and rt-PA

Maofeng Gong1, Guoping Chen1, Jianping Gu1,()   

  1. 1. Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
  • Received:2017-04-26 Published:2017-11-01
  • Corresponding author: Jianping Gu
  • About author:
    Corresponding author: Gu Jianping, Email:
引用本文:

公茂峰, 陈国平, 顾建平. 下肢深静脉血栓形成的溶栓治疗现状与尿激酶、阿替普酶的临床应用[J/OL]. 中华介入放射学电子杂志, 2017, 05(04): 282-287.

Maofeng Gong, Guoping Chen, Jianping Gu. Review of thrombolytic therapy for deep venous thrombosis and clinical application of urokinase and rt-PA[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2017, 05(04): 282-287.

下肢深静脉血栓形成是临床常见静脉回流障碍性血管疾病之一。在抗凝治疗基础上,溶栓治疗不失为一种积极有效的策略选择,深受国内外学者的关注。因此,探寻一个既能高效清除血栓又可减少出血的最佳纤溶药物、剂量和溶栓模式有着重要意义。目前,尿激酶和阿替普酶是国内外下肢深静脉血栓形成溶栓中最常应用的溶栓剂,对于溶栓药物的给药剂量及模式在不同研究机构中多为经验性应用。本文就目前下肢溶栓治疗中尿激酶和阿替普酶的溶栓速率、剂量、有效性及安全性的临床应用现状作一综述。

Deep venous thrombosis (DVT) is one of the most common venous reflux disorders in vascular disease. On the basis of anticoagulant therapy, thrombolytic therapy is an active and effective option that has drawn a wide attention of international researchers and clinicians in the field. Therefore, it is of great significance to explore the best thrombolytic drug, dosage and thrombolytic mode, which not only can effectively remove thrombus but also can reduce bleeding. At present, urokinase and rt-PA are the most prevalent thrombolytic agents in the treatment of DVT worldwide, and most of the studies on the dosage and mode of such thrombolytic drugs conducted by various research groups and labs stay at empirical level. In this article, we make a comprehensive review concerning the current situation of thrombolysis rate, dosage, efficacy and safety of urokinase and rt-PA in clinical application for DVT on thrombolysis.

1
中华医学会放射学分会介入学组.下肢深静脉血栓形成介入治疗规范的专家共识[J].中华放射学杂志,2011, 45(3):293-296. doi:10.3760/cma.j.issn.1005-1201.2011.03.014.
2
Rodriguez AL, Wojcik BM, Wrobleski SK,et al. Statins,inflammation and deep vein thrombosis: a systematic review[J]. J Thromb Thrombolysis,2012, 33(4):371-82. doi: 10.1007/s11239-012-0687-9.
3
Chen G, Shi W, He X, et al. Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding[J]. Exp Ther Med,2017, 13(2):751-758. doi:10.3892/etm.2017.4023.
4
Righini M, Le Gal G, Bounameaux H. Venous thromboembolism diagnosis: unresolved issues[J]. Thromb Haemost,2015,113(6):1184-1192. doi: 10.1160/TH14-06-0530.
5
Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: Chest guideline and expert panel report[J]. Chest,2016,149(2):315-152. doi: 10.1016/j.chest.2015.11.026.
6
Kahn SR, Shrier I, Julian JA, et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis[J]. Ann Intern Med,2008, 149(10):698-707.
7
Streiff MB, Agnelli G, Connors JM, et al. Guidance for the treatment of deep vein thrombosis and pulmonary embolism[J]. J Thromb Thrombolysis,2016, 41(1):32-67. doi: 10.1007/s11239-015-1317-0.
8
Haig Y, Enden T, Slagsvold CE, et al. Determinants of early and longterm efficacy of catheter-directed thrombolysis in proximal deep vein thrombosis[J]. J Vasc Interv Radiol,2013, 24(1):17-24; quiz 26. doi:10.1016/j.jvir.2012.09.023.
9
Enden T, Haig Y, Klow NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis(the CaVenT study): a randomised controlled trial[J]. Lancet, 2012, 379(9810): 31-38. doi: 10.1016/S0140-6736(11)61753-4.
10
Haig Y, Enden T, Grptta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis(CaVenT):5-year follow-up results of an open-label, randomised controlled trial[J]. Lancet Haematol, 2016, 3(2): e64-71. doi: 10.1016/S2352-3026(15)00248-3.
11
Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis[J].Cochrane Database Syst Rev, 2016, 11:CD002783.
12
Du XL, Kong LS, Meng QY, et al. Safety and efficacy of low dosage of urokinase for catheter-directed thrombolysis of deep venous thrombosis[J]. Chin Med J (Engl), 2015, 128(13): 1787-1792. doi: 10.4103/0366-6999.159355.
13
Kahn SR, Partsch H, Vedantham S,et al. Definition of postthrombotic syndrome of the leg for use in clinical investigations: a recommendation for standardization[J]. J Thromb Haemost, 2009, 7(5):879-883. doi: 10.1111/j.1538-7836.2009.03294.x.
14
Engelberger RP, Spirk D, Willenberg T, et al. Ultrasoundassisted versus conventional catheter-directed thrombolysis for acute iliofemoral deep vein thrombosis[J]. Circ Cardiovasc Interv, 2015, 8(1). pii: e002027. doi: 10.1161/CIRCINTERVENTIONS.114.002027.
15
Gacia MJ, Lookstein R, Malhotra R, et al. Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL(Peripheral Use of AngioJet Rheoiytic Thrombectomy with a variety of Catheter Lengths) Registry[J]. J Vasc Interv Radiol, 2015, 26(6): 777-785; quiz 786. doi: 10.1016/j.jvir.2015.01.036.
16
宋进华,何旭,楼文胜,等.急性髂股静脉血栓治疗中AngioJet机械性血栓清除装置初步应用结果[J].中华放射学杂志, 2015, 49(10):758-762.doi:10.3760/cma.j.issn.1005-1201.2015.10.009.
17
Du GC, Zhang MC, Zhao JC. Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis a meta analysis[J]. Vasa, 2015, 44(3):195-202. doi: 10.1024/0301-1526/a000430.
18
Vedantham S, Sista AK, Klein SJ, et al. Quality improvement guidelines for the treatment of lower-extremity deep vein thrombosis with use of endovascular thrombus removal[J]. J Vasc Interv Radiol, 2014, 25(9):1317-1325. doi: 10.1016/j.jvir.2014.04.019.
19
陈国平,顾建平,何旭,等.顺行与逆行插管途径介入治疗急性下肢深静脉血栓形成的疗效比较[J].中华医学杂志, 2017, 97(5):353-358.doi:10.3760/cma.j.issn.0376-2491.2017.05.007.
20
刘辉,承文龙,卢辉俊.导管溶栓与系统溶栓治疗急性下肢深静脉血栓形成的Meta分析[J].中国血管外科杂志:电子版, 2016, 8(3):183-187.doi:10.3969/j.issn.1674-7429.2016.03.005.
21
Vedantham S, Piazza G, Sista AK, et al. Guidance for the use of thrombolytic therapy for the treatment of venous thromboembolism [J]. J Thromb thrombolysis,2016,41(1):68-80. doi:10.1007/s11239-015-1318-z.
22
Jeon YS, Yoon YH, Cho JY, et al. Catheter-directed thrombolysis with conventional aspiration thrombectomy for lower extremity deep vein thrombosis[J].Yonsei Med J, 2010, 51(2):197-201. doi: 10.3349/ymj.2010.51.2.197.
23
Fiengo L, Bucci F, Khalil E, et al. Original approach for thrombolytic therapy in patients with Ilio-femoral deep vein thrombosis: 2 years follow-up[J]. Thromb J, 2015,13:40. doi: 10.1186/s12959-015-0070-0.
24
Khan JU, Takemoto CM, Casella JF, et al. Catheter-directed thrombolysis of inferior vena cava thrombosis in a 13-day-old neonate and review of literature[J]. Cardiovasc Intervent Radiol, 2008, 31(Suppl 2):S153-160.
25
Kukreja KU, Lungren MP, Patel MN, et al. Endovascular venous thrombolysis in children younger than 24 months[J]. J Vasc Interv Radiol, 2014, 25(8):1158-1164. doi: 10.1016/j.jvir.2014.04.003.
26
Grünewald M, Griesshammer M, Ellbrück D, et al. Loco-regional thrombolysis for deep vein thrombosis: fact or fiction A study of hemostatic parameters[J]. Blood Coagul Fibrinolysis, 2000, 11(6):529-536.
27
Sharifi M, Bay C, Nowroozi S, et al. Catheter-directed thrombolysis with argatroban and tPA for massive iliac and femoropopliteal vein thrombosis[J]. Cardiovasc Intervent Radiol, 2013, 36(6):1586--590. doi: 10.1007/s00270-013-0569-3.
28
Lungren MP, Ward TJ, Patel MN, et al. Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results[J]. J Thromb Thrombolysis, 2015, 40(3):274-279. doi: 10.1007/s11239-015-1209-3.
29
Mewissen MW, Seabrook GR, Meissner MH, et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry[J].Radiology, 1999, 211(1):39-49.
30
Xue GH, Huang XZ, Ye M, et al. Catheter-directed thrombolysis and stenting in the treatment of iliac vein compression syndrome with acute iliofemoral deep vein thrombosis: outcome and follow-up[J]. Ann Vasc Surg, 2014, 28(4):957-963. doi: 10.1016/j.avsg.2013.11.012.
31
Manninen H, Juutilainen A, Kaukanen E, et al. Catheter-directed thrombolysis of proximal lower extremity deep vein thrombosis: a prospective trial with venographic and clinical follow-up[J]. Eur J Radiol, 2012, 81(6):1197-1202. doi: 10.1016/j.ejrad.2011.03.068.
32
Lee K, Istl A, Dubois L, et al. Fibrinogen level and bleeding risk during catheter-directed thrombolysis using tissue plasminogen activator[J]. Vasc Endovascular Surg, 2015, 49(7): 175-179. doi: 10.1177/1538574415611234.
33
Chang R, Horne MK 3rd, Shawker TH, et al. Low-dose, once-daily, intraclot injections of alteplase for treatment of acute deep venous thrombosis[J]. J Vasc Interv Radiol, 2011, 22(8): 1107-1116. doi: 10.1016/j.jvir.2011.03.023.
34
Gurman P, Miranda O, Nathan A, et al. Recombinant tissue plasminogen activators(rtPA): a review[J]. Clin Pharmacol Ther, 2015, 97(3):274-285. doi: 10.1002/cpt.33.
35
Sugimoto K, Hofmann LV, Razavi MK, et al. The safety, efficacy, and pharmacoeconomics of low-dose alteplase compared with urokinase for catheter-directed thrombolysis of arterial and venous occlusions[J]. J Vasc Surg, 2003, 37(3):512-517.
36
Grunwald MR, Hofmann LV. Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis[J]. J Vasc Interv Radio, 2004, 15(4):347-352.
37
Howard LS, Hughes RJ. NICE guideline: management of venous thromboembolic diseases and role of thrombophilia testing[J]. Thorax, 2013, 68(4):391-393. doi: 10.1136/thoraxjnl-2012-202376.
38
Collen D, Stassen JM, Yasuda T, et al. Comparative thrombolytic properties of tissue-type plasminogen activator and of a plasminogen activator inhibitor-1-resistant glycosylation variant, in a combined arterial and venous thrombosis model in the dog[J]. Thromb Haemost, 1994,72(1):98-104.
39
Monagle P, Chalmers E, Chan A, et al. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)[J]. Chest, 2008, 133(6 Suppl): 887S-968S. doi: 10.1378/chest.08-0762.
40
中华医学会外科学分会血管外科学组.深静脉血栓形成的诊断和治疗指南(第2版)[J].中华外科杂志, 2012, 50(7):611-614.doi: 10.3760/cma.j.issn.0529-5815.2012.07.010.
41
Jaff MR, Mcmurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension a scientific statement from the American Heart Association[J]. Circulation,2011,123(16):1788-830. doi: 10.1161/CIR.0b013e318214914f.
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