PMID- 11171740
OWN - NLM
STAT- MEDLINE
DCOM- 20010405
LR  - 20190514
IS  - 0012-3692 (Print)
IS  - 0012-3692 (Linking)
VI  - 119
IP  - 2
DP  - 2001 Feb
TI  - Tissue plasminogen activator for the treatment of deep venous thrombosis of the 
      lower extremity: a systematic review.
PG  - 572-9
AB  - OBJECTIVE: To assess, by systematic review, the efficacy and safety of 
      recombinant tissue plasminogen activator (rt-PA) in the treatment of lower 
      extremity deep venous thrombosis (DVT). A secondary objective is to assess the 
      optimal dose and route of administration of rt-PA. METHODS: Included studies were 
      randomized, controlled trials comparing rt-PA plus unfractionated heparin (UFH) 
      to UFH alone, rt-PA at different doses, or rt-PA by different routes of 
      administration in the treatment of DVT. Outcomes had to be described in terms of 
      percent change in venographic patency for efficacy (>50% lysis) and in sufficient 
      detail for complications (major and minor hemorrhages and other). The search 
      strategy included searching electronic databases and contacting pharmaceutical 
      agencies and content experts. Study quality was assessed using the Jadad scale. A 
      threshold quality score was used to exclude trials. RESULTS: Five studies met the 
      following inclusion criteria: three comparing rt-PA plus UFH vs UFH alone (180 
      patients); one comparing high-dose vs low-dose rt-PA (32 patients); and one 
      comparing systemic vs local administration of rt-PA (151 patients). In studies 
      comparing rt-PA vs placebo, patients assigned to rt-PA were more likely to have > 
      50% lysis and complications (summary odds ratios [OR], 11.7; 95% confidence 
      interval [CI], 2.61 to 52.5; and OR, 9.95; 95% CI, 2.21 to 44.7, respectively). 
      Major and intracerebral hemorrhages were not significantly increased. One study 
      comparing different doses demonstrated that high-dose and low-dose rt-PA were 
      equally efficacious (OR, 0.88; 95% CI, 0.05 to 14.78). Local rt-PA was neither 
      more efficacious nor riskier than systemic rt-PA. CONCLUSION: This systematic 
      review does not support routine use of rt-PA for DVT.
FAU - Forster, A
AU  - Forster A
AD  - Division of General Internal Medicine, Ottawa Hospital, Civic Campus, University 
      of Ottawa, Ontario, Canada.
FAU - Wells, P
AU  - Wells P
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Chest
JT  - Chest
JID - 0231335
RN  - 0 (Anticoagulants)
RN  - 0 (Fibrinolytic Agents)
RN  - 9005-49-6 (Heparin)
RN  - EC 3.4.- (Streptokinase)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
SB  - IM
MH  - Anticoagulants/therapeutic use
MH  - Cerebral Hemorrhage/prevention & control
MH  - Fibrinolytic Agents/administration & dosage/*therapeutic use
MH  - Heparin/therapeutic use
MH  - Humans
MH  - Randomized Controlled Trials as Topic
MH  - Streptokinase/therapeutic use
MH  - Tissue Plasminogen Activator/administration & dosage/*therapeutic use
MH  - Venous Thrombosis/*drug therapy
RF  - 29
EDAT- 2001/02/15 11:00
MHDA- 2001/04/06 10:01
CRDT- 2001/02/15 11:00
PHST- 2001/02/15 11:00 [pubmed]
PHST- 2001/04/06 10:01 [medline]
PHST- 2001/02/15 11:00 [entrez]
AID - S0012-3692(15)38239-8 [pii]
AID - 10.1378/chest.119.2.572 [doi]
PST - ppublish
SO  - Chest. 2001 Feb;119(2):572-9. doi: 10.1378/chest.119.2.572.