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Semin intervent Radiol 2005; 22(2): 121-129
DOI: 10.1055/s-2005-871867
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Differentiating Pharmacologic Agents Used In Catheter-Directed Thrombolysis

James L. Swischuk1 , H. Bob Smouse1
  • 1Department of Radiology, University of Illinois College of Medicine at Peoria, Peoria, Illinois
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Publication History

Publication Date:
28 June 2005 (online)

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ABSTRACT

The use of catheter-directed thrombolysis is a proven treatment for arterial ischemia, deep vein thrombosis, and severe pulmonary embolism. For arterial ischemia, thrombolysis has resulted in improved amputation-free survival and fewer subsequent surgeries to reestablish blood flow to the ischemic limb. The management of patients with thromboembolic diseases is complex, and the multiple thrombolytic drugs available to choose from compound this complexity. Although some believe the available thrombolytic agents are interchangeable, real biochemical differences exist that may prove otherwise. This article describes these pharmacologic differences and how they may affect the clinical practice of catheter-directed thrombolysis.

KEYWORDS

Thrombolysis - catheter-directed thrombolysis - pharmacology - bleeding complications

REFERENCES

  • 1 Ouriel K, Shortell C K, DeWeese J A et al.. A comparison of thrombolytic therapy with operative revascularization in the initial treatment of acute peripheral arterial ischemia.  J Vasc Surg. 1994;  19 1021-1030
    CrossrefPubMedSearch in Google Scholar
  • 2 Weaver F A, Comerota A J, Youngblood M, Froehlich J, Hosking J D, Papanicolaou G. Surgical revascularization versus thrombolysis for nonembolic lower extremity native artery occlusions: results of a prospective randomized trial. The STILE Investigators. Surgery versus Thrombolysis for Ischemia of the Lower Extremity.  J Vasc Surg. 1996;  24 513-521 discussion 521-523
    CrossrefPubMedSearch in Google Scholar
  • 3 Ouriel K, Veith F J, Sasahara A A. Thrombolysis or peripheral arterial surgery: phase I results. TOPAS Investigators.  J Vasc Surg. 1996;  23 64-73 discussion 74-75
    CrossrefPubMedSearch in Google Scholar
  • 4 Ouriel K, Veith F J, Sasahara A A. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators.  N Engl J Med. 1998;  338 1105-1111
    CrossrefPubMedSearch in Google Scholar
  • 5 Tillet W S, Garner R L. The fibrinolytic activity of hemolytic streptococci.  J Exp Med. 1933;  58 485-502
    CrossrefPubMedSearch in Google Scholar
  • 6 Christensen L R, MacLeod C M. A proteolytic enzyme of serum: characterization, activation and reaction with inhibitors.  J Gen Physiol. 1945;  28 559-583
    CrossrefPubMedSearch in Google Scholar
  • 7 Bell W R. Therapeutic agents: pharmacokinetics and pharmacodynamics.  Rev Cardiovasc Med. 2002;  3(suppl 2) s34-s44
    PubMedSearch in Google Scholar
  • 8 van Breda A, Katzen B T, Deutsch A S. Urokinase versus streptokinase in local thrombolysis.  Radiology. 1987;  165 109-111
    PubMedSearch in Google Scholar
  • 9 Graor R A, Young J R, Risius B, Ruschhaupt W F. Comparison of cost effectiveness of streptokinase and urokinase in the treatment of deep vein thrombosis.  Ann Vasc Surg. 1987;  1 524-528
    PubMedSearch in Google Scholar
  • 10 Tennant S N, Dixon J, Venable T C et al.. Intracoronary thrombolysis in patients with acute myocardial infarction: comparison of the efficacy of urokinase with streptokinase.  Circulation. 1984;  69 756-760
    PubMedSearch in Google Scholar
  • 11 Williams J RB. The fibrinolytic activity of the urine.  Br J Exp Pathol. 1951;  32 530-537
    PubMedSearch in Google Scholar
  • 12 Sobel G W, Mohler S R, Jones N W et al.. Urokinase: an activator of plasma profibrinolysin extracted from urine.  Am J Physiol. 1952;  171 768-769
    PubMedSearch in Google Scholar
  • 13 Barlow G H, Lazer L. Characterization of the plasminogen activator isolated from human embryo kidney cells: comparison with urokinase.  Thromb Res. 1972;  1 201-208
    CrossrefPubMedSearch in Google Scholar
  • 14 Bernik M B, White W F, Oller E P, Kwaan H C. Immunologic identity of plasminogen activator in human urine, heart, blood vessels, and tissue culture.  J Lab Clin Med. 1974;  84 546-558
    PubMedSearch in Google Scholar
  • 15 Mewissen M W, Seabrook G R, Meissner M H, Cynamon J, Labropoulos N, Haughton S H. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry.  Radiology. 1999;  211 39-49
    CrossrefPubMedSearch in Google Scholar
  • 16 Cragg A H, Smith T P, Corson J D et al.. Two urokinase dose regimens in native arterial and graft occlusions: initial results of a prospective, randomized clinical trial.  Radiology. 1991;  178 681-686
    PubMedSearch in Google Scholar
  • 17 Lijnen H R, Van Hoef B, De Cock F, Collen D. The mechanism of plasminogen activation and fibrin dissolution by single chain urokinase-type plasminogen activator in a plasma milieu in vitro.  Blood. 1989;  73 1864-1872
    PubMedSearch in Google Scholar
  • 18 Ouriel K, Kandarpa K, Schuerr D M, Hultquist M, Hodkinson G, Wallin B. Prourokinase versus urokinase for recanalization of peripheral occlusions, safety and efficacy: the PURPOSE trial.  J Vasc Interv Radiol. 1999;  10 1083-1091
    CrossrefPubMedSearch in Google Scholar
  • 19 Swischuk J L, Fox P F, Young K et al.. Transcatheter intraarterial infusion of rt-PA for acute lower limb ischemia: results and complications.  J Vasc Interv Radiol. 2001;  12 423-430
    CrossrefPubMedSearch in Google Scholar
  • 20 Wooster M B, Luzier A B. Reteplase: a new thrombolytic for the treatment of acute myocardial infarction.  Ann Pharmacother. 1999;  33 318-324
    PubMedSearch in Google Scholar
  • 21 Martin U, Sponer G, Strein K. Evaluation of thrombolytic and systemic effects of the novel recombinant plasminogen activator BM 06.022 compared with alteplase, anistreplase, streptokinase and urokinase in a canine model of coronary artery thrombosis.  J Am Coll Cardiol. 1992;  19 433-440
    PubMedSearch in Google Scholar
  • 22 Bode C, Smalling R W, Berg G et al.. Randomized comparison of coronary thrombolysis achieved with double-bolus reteplase (recombinant plasminogen activator) and front-loaded, accelerated alteplase (recombinant tissue plasminogen activator) in patients with acute myocardial infarction. The RAPID II Investigators.  Circulation. 1996;  94 891-898
    PubMedSearch in Google Scholar
  • 23 A comparison of reteplase with alteplase for acute myocardial infarction. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators.  N Engl J Med. 1997;  337 1118-1123
    CrossrefPubMedSearch in Google Scholar
  • 24 Stewart R J, Fredenburgh J C, Leslie B A, Keyt B A, Rischke J A, Weitz J I. Identification of the mechanism responsible for the increased fibrin specificity of TNK-tissue plasminogen activator relative to tissue plasminogen activator.  J Biol Chem. 2000;  275 10112-10120
    CrossrefPubMedSearch in Google Scholar
  • 25 Burkart D J, Borsa J J, Anthony J P, Thurlo S R. Thrombolysis of occluded peripheral arteries and veins with tenecteplase: a pilot study.  J Vasc Interv Radiol. 2002;  13 1099-1102
    PubMedSearch in Google Scholar
  • 26 Razavi M K, Wong H, Kee S T, Sze D Y, Semba C P, Dake M D. Initial clinical results of tenecteplase (TNK) in catheter-directed thrombolytic therapy.  J Endovasc Ther. 2002;  9 593-598
    CrossrefPubMedSearch in Google Scholar
  • 27 Castaneda F, Swischuk J L, Li R, Young K, Smouse B, Brady T. Declining-dose study of reteplase treatment for lower extremity arterial occlusions.  J Vasc Interv Radiol. 2002;  13 1093-1098
    PubMedSearch in Google Scholar
  • 28 Chesebro J H, Knatterud G, Roberts R et al.. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge.  Circulation. 1987;  76 142-154
    PubMedSearch in Google Scholar
  • 29 McLeod D C, Coln W G, Thayer C F, Perfetto E M, Hartzema A G. Pharmacoepidemiology of bleeding events after use of r-alteplase or streptokinase in acute myocardial infarction.  Ann Pharmacother. 1993;  27 956-962
    PubMedSearch in Google Scholar
  • 30 The GUSTO Investigators . An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction.  N Engl J Med. 1993;  329 673-682
    CrossrefPubMedSearch in Google Scholar
  • 31 Collaborative Group . ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. ISIS-3 (Third International Study of Infarct Survival).  Lancet. 1992;  339 753-770
    PubMedSearch in Google Scholar
  • 32 The International Study Group . In-hospital mortality and clinical course of 20,891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin.  Lancet. 1990;  336 71-75
    CrossrefPubMedSearch in Google Scholar
  • 33 Collaborative Group . Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival).  J Am Coll Cardiol. 1988;  12(suppl A) 3A-13A
    PubMedSearch in Google Scholar
  • 34 Berkowitz S D, Granger C B, Pieper K S et al.. Incidence and predictors of bleeding after contemporary thrombolytic therapy for myocardial infarction. The Global Utilization of Streptokinase and Tissue Plasminogen activator for Occluded coronary arteries (GUSTO) I Investigators.  Circulation. 1997;  95 2508-2516
    PubMedSearch in Google Scholar
  • 35 Ouriel K, Kandarpa K. Safety of thrombolytic therapy with urokinase or recombinant tissue plasminogen activator for peripheral arterial occlusion: a comprehensive compilation of published work.  J Endovasc Ther. 2004;  11 436-446
    CrossrefPubMedSearch in Google Scholar
  • 36 Rao A K, Pratt C, Berke A et al.. Thrombolysis in Myocardial Infarction (TIMI) Trial-phase I: hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase.  J Am Coll Cardiol. 1988;  11 1-11
    CrossrefPubMedSearch in Google Scholar
  • 37 Bovill E G, Terrin M L, Stump D C et al.. Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial.  Ann Intern Med. 1991;  115 256-265
    PubMedSearch in Google Scholar
  • 38 Weitz J I, Leslie B, Ginsberg J. Soluble fibrin degradation products potentiate tissue plasminogen activator-induced fibrinogen proteolysis.  J Clin Invest. 1991;  87 1082-1090
    CrossrefPubMedSearch in Google Scholar
  • 39 Weitz J I, Rischke J. The role of (DD)E in the kinetics of plasminogen activation by tissue plasminogen activator.  Thromb Haemost. 1993;  69 544 , Abstract
    PubMedSearch in Google Scholar
  • 40 Pizzo S V, Schwartz M L, Hill R L, McKee P A. The effect of plasmin on the subunit structure of human fibrinogen.  J Biol Chem. 1972;  247 636-645
    PubMedSearch in Google Scholar
  • 41 Weitz J I, Koehn J A, Canfield R E, Landman S L, Friedman R. Development of a radioimmunoassay for the fibrinogen-derived peptide B beta 1-42.  Blood. 1986;  67 1014-1022
    PubMedSearch in Google Scholar
  • 42 Shen L L, McDonagh R P, McDonagh J, Hermans J. Early events in the plasmin digestion of fibrinogen and fibrin. Effects of plasmin on fibrin polymerization.  J Biol Chem. 1977;  252 6184-6189
    PubMedSearch in Google Scholar
  • 43 Sato H, Weisel J W. Polymerization of fibrinogen-derived fragment X and subsequent rearrangement of fibers.  Thromb Res. 1990;  58 205-212
    CrossrefPubMedSearch in Google Scholar
  • 44 Weitz J I, Leslie B, Hirsh J, Klement P. Alpha 2-antiplasmin supplementation inhibits tissue plasminogen activator-induced fibrinogenolysis and bleeding with little effect on thrombolysis.  J Clin Invest. 1993;  91 1343-1350
    CrossrefPubMedSearch in Google Scholar
  • 45 Owen J, Friedman K D, Grossman B A, Wilkins C, Berke A D, Powers E R. Quantitation of fragment X formation during thrombolytic therapy with streptokinase and tissue plasminogen activator.  J Clin Invest. 1987;  79 1642-1647
    PubMedSearch in Google Scholar
  • 46 Sugimoto K, Hofmann L V, Razavi M K et al.. The safety, efficacy, and pharmacoeconomics of low-dose alteplase compared with urokinase for catheter-directed thrombolysis of arterial and venous occlusions.  J Vasc Surg. 2003;  37 512-517
    CrossrefPubMedSearch in Google Scholar
  • 47 Grunwald M R, Hofmann L V. Comparison of urokinase, alteplase, and reteplase for catheter-directed thrombolysis of deep venous thrombosis.  J Vasc Interv Radiol. 2004;  15 347-352
    CrossrefPubMedSearch in Google Scholar
  • 48 Ouriel K, Gray B, Clair D G, Olin J. Complications associated with the use of urokinase and recombinant tissue plasminogen activator for catheter-directed peripheral arterial and venous thrombolysis.  J Vasc Interv Radiol. 2000;  11 295-298
    PubMedSearch in Google Scholar
  • 49 Cina C S, Goh R H, Chan J et al.. Intraarterial catheter-directed thrombolysis: urokinase versus tissue plasminogen activator.  Ann Vasc Surg. 1999;  13 571-575
    CrossrefPubMedSearch in Google Scholar
  • 50 Semba C P, Bakal C W, Calis K A et al.. Alteplase as an alternative to urokinase. Advisory Panel on Catheter-Directed Thrombolytic Therapy.  J Vasc Interv Radiol. 2000;  11 279-287
    PubMedSearch in Google Scholar

James L SwischukM.D. 

Department of Radiology, University of Illinois College of Medicine at Peoria

1 Illini Drive, Peoria, IL 61605