NICE, FRANCE — Adding AngioJet percutaneous mechanical thrombectomy to catheter-directed urokinase thrombolysis can shorten treatment time and reduce lytic doses by close to half, Dr. Hyun S. Kim reported at the annual meeting of the Cardiovascular and Interventional Radiological Society of Europe.
Comparing clinical outcomes in patients treated with the combination with outcomes in those treated with thrombolysis alone, he said the dual-therapy patients fared “similarly, if not slightly better” in a small single-institution study.
Dr. Kim, a radiologist at Johns Hopkins University, Baltimore, and his coinvestigators compared the two approaches in consecutive patients with upper and lower extremity thromboses. The population had a mean age of 44.3 years.
Clinicians used urokinase therapy alone to treat 35 limbs in 31 patients, 11 of whom were men. A total of 20 patients, including 10 males, underwent urokinase therapy and thrombectomy for treatment of 26 limbs.
The mean duration of therapy was 26.4 hours with the combination therapy vs. 48.1 hours with urokinase therapy alone. Mean lytic dose also was much less with the combined treatment: 2.7 million units vs. 5.8 million units with urokinase alone. Both differences were statistically significant.
Dr. Kim reported achieving complete clot lysis in 80.8% (21/26) of limbs treated with the combination. The remaining 19.2% (5/26) had partial lysis. None of these patients had persistent thrombosis.
Among the group treated only with urokinase therapy, 74.3% (26/35) of limbs achieved complete clot lysis, and 11.4% (4/35) had partial lysis. Thrombosis persisted in 14.3% (5/35).
Dr. Kim reported no patient in either group had major bleeding. No recurrences or worsening of clotting had occurred at 30 days of follow-up.
Deep vein thrombosis is the third most common cardiovascular disease in the United States, according to Dr. Kim. “Despite multiple studies, percutaneous treatments have not as yet been established as the standard of care in the United States,” he said.
By combining percutaneous and urokinase therapies, his group addressed three reasons why clinicians are “adamant” about not using percutaneous treatments. Dr. Kim said clinicians argue that “(1) the treatment may take too long, and because of the long duration of therapy, there is (2) potential for hemorrhage.” The third reason, he said, is the high cost of treatment compared with therapy with warfarin or heparin.
In his conclusion, Dr. Kim predicted a role for percutaneous mechanical thrombectomy because the combination produced “better results than catheter-directed urokinase thrombolysis alone.”