Interventional treatment by catheter-directed thrombolysis for subacute iliofemoral venous thrombosis: comparison of instant efficacy between recombinant human tissue plasminogen activator and urokinase

Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase (UK) in catheter-directed thrombolysis (CDT) for the treatment of subacute iliofemoral deep venous thrombosis (DVT) . Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study. The patients were divided into three groups for comparison: rt-PA-CDT group (n=43) , UK-CDT group (n=39) and anticoagulation group (n=34) . The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test (accorded to normal distribution) was used to analyze the thrombolysis duration. The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups (P>0.05) . The thrombolysis duration, total dosages and thrombolytic rate (≥50) were (5.8±1.3) d, (49.7±16.1) mg, 86.0% for rt-PA-CDT group, and (6.3±1.5) d, (440±99) ×104 U, 66.7% for UK-CDT group. The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group (t=-1.868, P>0.05) . The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group (χ2=4.315, P 0.05) . No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3% (7/43) , 17.9% (7/39) and 8.8% (3/34) , respectively, and there were no significant differences among the three groups (χ2=1.396, P>0.05) . Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment. Thrombolytic rate of rt-PA is superior to UK. Key words: Venous thrombosis; Subacute; Urokinase; rt-PA; Catheter-directed thrombosis; Comparative study