Recombinant Tissue Plasminogen Activator Treatment of Pulmonary Embolism Also Improves Deep Venous Thrombosis

Abstract

Anticoagulants are the standard form of treatment used in deep vein thrombosis (DVT). Thrombolytic therapy is another method to treat thromboembolism by using intravenous administration of streptokinase, urokinase and recombinant tissue plasminogen activator (r-tPA). We have investigated the effect of r-tPA, a systemic thrombolytic used for the treatment of pulmonary emboli, on DVT in the same patients. 130 patients who were diagnosed with both pulmonary embolism and DVT were included in this study. Lower extremity Doppler ultrasonography (DUS) was conducted on all of the patients upon admission and then on the 6th month. The patients were divided into two groups. Patıents in Group 1 were initially given 100 mg thrombolytic (r-tPA) intravenously and then standard anticoagulation therapy (enoxaparin sodium and warfarin). Patients in Group 2, however, were given only standard anticoagulation therapy (enoxaparin sodium and warfarin). In the 6th month DUS follow-up control for Group 1, out of 66 cases, the venous thrombosis of 54 patients were completely resolved, and the remaining 12 patients had residual vein occlusion (RVO). In Group 2, out of 64 cases, 41 patients were found to have complete resolution, while 23 patients continued to have RVO. This difference was statistically significant (p=0.029). OR was calculated to be 2.47. In other words, the risk of RVO was increased by 2.47 times in the patients who were not treated with r-tPA. Thrombolytic therapy of DVT should be considered more frequently to avoid complications of thrombosis, and DUS monitoring should be recommended before discontinuing anticoagulant therapy.