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Evidence summaries

Surgery Versus Thrombolysis for Initial Management of Acute Limb Ischaemia

There appears not to be differences in limb salvage, amputation, or death between initial surgery and initial thrombolysis for the management of acute limb ischaemia, but there may be higher incidence of major haemorrhage and distal embolisation with thrombolysis. The higher risk of complications must be balanced against individual risks in surgery. Level of evidence: "B"

The quality of evidence is downgraded by inconsistency (variability in results).

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 1 292 subjects comparing thrombolysis and surgery in the initial management of acute limb ischaemia due to thromboembolism. Agents used for thrombolysis were recombinant tissue plasminogen activator and urokinase.

No clear differences were observed in limb salvage (OR 1.02, 95% CI 0.41 to 2.55; 4 studies, n=636; statistical heterogeneity I2 =56%), amputation (OR 0.97, 95% CI 0.51 to 1.85; 3 studies, n=616), or death (OR 0.59, 95% CI 0.31 to 1.14; 4 studies, n= 636) at 30 days between thrombolysis and surgery. Also, no clear differences were observed for any of the 3 outcomes at 6 months or 1 year. Thrombolysis treatment increased risk of major haemorrhage (OR 3.22, 95% CI 1.79 to 5.78; 4 studies, n=1 070) and distal embolisation (OR 31.68, 95% CI 6.23 to 161.07; 3 studies, n=678) at 30 days compared to surgery. No clear difference in stroke at 30 days was observed (OR 5.33, 95% CI 0.95 to 30.11; 5 studies, n=1 180) between thrombolysis and surgery.

    References

    • Darwood R, Berridge DC, Kessel DO et al. Surgery versus thrombolysis for initial management of acute limb ischaemia. Cochrane Database Syst Rev 2018;(8):CD002784. [PubMed]

Primary/Secondary Keywords