Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

Summary

The feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.

Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

• References

• 1 ten Cate JW, Koopman MM, Prins MH, Buller HR. Treatment of venous thromboembolism.. Thromb Haemost 1995; 74: 197-203.
• 2 Francis CW, Marder VJ. Fibrinolytic therapy for venous thrombosis.. Prog Cardiovasc Dis 1991; 34: 193-204.
• 3 Comerota AJ, Aldridge SC. Thrombolytic therapy for deep venous thrombosis: a clinical review.. Can J Surg 1993; 36: 359-64.
• 4 Goldhaber SZ. Venous thrombosis: prevention, treatment, and relationship to paradoxical embolization.. Cardiol Clin 1994; 12: 505-16.
• 5 Goldhaber SZ, Buring JE, Lipnick RJ, Hennekens CH. Pooled analysis of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis.. Am J Med 1984; 76: 393-7.
• 6 Verstraete M. Thrombolytic therapy of non-cardiac disorders.. Baillières Clin Haematol 1995; 8: 413-24.
• 7 Verhaeghe R, Stockx L, Lacroix H, Vermylen J, Baert AL. Catheter-directed lysis of iliofemoral vein thrombosis with use of rt-PA.. Eur Radiol 1997; 7: 996-1001.
• 8 Semba CP, Dake MD. Ileofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis.. Radiology 1994; 191: 487-94.
• 9 Comerota AJ, Aldridge SC, Cohen G, Ball DS, Pliskin M, White JV. A strategy of aggressive regional therapy for acute ileofemoral venous thrombosis with contemporary venous thromboectomy or catheter-directed thrombolysis.. J Vasc Surg 1994; 20: 244-54.
• 10 Collen D, Lijnen H. Staphylokinase, a fibrin specific plasminogen activator with therapeutic potential?. Blood 1994; 84: 680-6.
• 11 Collen D, Van de Werf F. Coronary thrombolysis with recombinant staphylokinase in patients with evolving myocardeal infarction.. Circulation 1993; 87: 1850-3.
• 12 Vanderschueren S, Barrios L, Kerdsinchai P, Van den Heuvel P, Hermans L, Vrolix M, De Man F, Benit E, Muyldermans L, Collen D, Van de Werf F. A randomized trial of recombinant staphylokinase versus alteplase for coronary artery patency in acute myocardial infarction.. Circulation 1995; 92: 2044-9.
• 13 Vanderschueren S, Stockx L, Wilms G, Lacroix H, Verhaeghe R, Vermylen J, Collen D. Thrombolytic therapy of peripheral arterial occlusion with recombinant staphylokinase.. Circulation 1995; 92: 2050-7.
• 14 Schlott B, Hartmann M, Gührs KH, Birch-Hirschfeid E, Pohl HD, Vanderschueren S, Van de Werf F, Michoel A, Collen D, Behnke D. High yield production and purification of recombinant staphylokinase for thrombolytic therapy.. Biotechnology NY 1994; 12: 185-9.
• 15 Smitz Rode T, Vorwerk D, Schurmann K, Gunther RW. Experimental impeller fragmentation of iliocaval thrombosis under tulip filter protection: preliminary results.. Cardiovasc Interv Radiol 1996; 19: 260-4.
• 16 O’Meara J, McNutt RA, Evans AT. A decision analysis of streptokinase plus heparin as compared with heparin alone for deep-vein thrombosis.. N Engl J Med 1994; 330: 1864-9.
• 17 Goldhaber SZ, Meyerovitz MF, Green D, Kim H. et al. Randomized controlled trial of tissue plasminogen activator in proximal deep venous thrombosis.. Am J Med 1990; 88: 235-40.
• 18 Verhaeghe R, Besse P, Bounameaux H, Marbet GA. Multicenter pilot study of the efficacy and safety of systemic rt-PA administration in the treatment of deep vein thrombosis of the lower extremities and/or pelvis.. Thromb Res 1989; 55: 5-11.