Bleeding Issues During Thrombolysis for Acute Leg Ischaemia.

When we started testing catheter directed low dose thrombolysis (CDT) for acute leg ischaemia (ALI) in the 1980s, it was the first time endovascular intervention advanced beyond simple balloon angioplasty. In many respects, CDT kick started the endovascular revolution. Clots could be removed without surgery, and from arteries too small for embolectomy catheters to reach. But there was a price to pay: thrombolytic drugs caused bleeding, mainly from catheter puncture sites, but also from distant areas, such as haemorrhagic stroke. The latter was unpredictable, but fortunately rare. 1 Earnshaw J.J. Whitman B. Foy C for the Thrombolysis Study GroupNational Audit of Thrombolysis for Acute Leg Ischemia (NATALI): Clinical factors associated with early outcome. J Vasc Surg. 2004; 39: 1018-1025 Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar Major Bleeding During Thrombolytic Therapy for Acute Lower Limb Ischaemia: Value of Laboratory Tests for Clinical Decision Making, 17 Years of ExperienceEuropean Journal of Vascular and Endovascular SurgeryVol. 65Issue 3PreviewRegular measurement of fibrinogen as dose guidance in catheter directed thrombolysis (CDT) for acute limb ischaemia (ALI) has recently been dropped from European guidelines based on inconsistent literature. This study aimed to determine whether low fibrinogen levels and high activated partial thromboplastin time (APTT) are associated with an increased major bleeding risk during CDT. Full-Text PDF Open Access