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Evidence summaries

Fibrinolytic Agents for Peripheral Arterial Occlusion

Intra-arterial recombinant tissue plasminogen activator (rt-PA) might possibly be more effective than intra-arterial streptokinase or intravenous rt-PA in improving vessel patency in people with peripheral arterial occlusion although the evidence is insufficient. Level of evidence: "D"

A Cochrane review [Abstract] 1 included 5 studies with a total of 687 subjects with a wide range of clinical presentations from intermittent claudication to critical limb ischaemia. In one three-pronged study, vessel patency was greater with intra-arterial recombinant tissue plasminogen activator (rt-PA) than with intra-arterial streptokinase (P < 0.04) or intravenous rt-PA (P < 0.01). In patients with peripheral arterial occlusion there was no statistically significant difference in limb salvage at 30 days with either urokinase or rt-PA, though this may reflect the small numbers in the studies. Incidences of haemorrhagic complications varied with fibrinolytic regime but there was no statistically significant difference between intra-arterial urokinase and intra-arterial rt-PA. In the three-pronged study intravenous rt-PA and intra-arterial streptokinase were associated with a significantly higher risk of haemorrhagic complications than intra-arterial rt-PA (P < 0.05).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in patients, interventions and outcomes), and by imprecise results (limited study size for each comparison).

    References

    • Robertson I, Kessel DO, Berridge DC. Fibrinolytic agents for peripheral arterial occlusion. Cochrane Database Syst Rev 2013;(12):CD001099. [PubMed]

Primary/Secondary Keywords