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Risk factors for hemorrhage during local intra-arterial thrombolysis for lower limb ischaemia

Kuoppala, Monica LU ; Åkeson, Jonas LU ; Svensson, Peter LU ; Lindblad, Bengt LU ; Franzén, Sofia LU and Acosta, Stefan LU (2011) In Journal of Thrombosis and Thrombolysis 31(2). p.226-232
Abstract
Assessment of clinical risk factors for haemorrhagic complications in patients undergoing intra-arterial thrombolysis for lower limb ischaemia. Retrospective reviews of consecutive patients subjected to intra-arterial thrombolysis due to lower limb ischemia at the Vascular Center, Malmö University Hospital, during a 5-year period from 2001 to 2005. Two hundred and twenty intra-arterial thrombolytic procedures were carried out in 195 patients (46% women), median age 73 years. Haemorrhagic complications were recorded in 72 procedures (33%), of which 13 were discontinued. Haemorrhage at the introducer and distant sites occurred in 53 and 32 procedures, respectively. Thrombolysis for occluded synthetic grafts was associated with higher risk of... (More)
Assessment of clinical risk factors for haemorrhagic complications in patients undergoing intra-arterial thrombolysis for lower limb ischaemia. Retrospective reviews of consecutive patients subjected to intra-arterial thrombolysis due to lower limb ischemia at the Vascular Center, Malmö University Hospital, during a 5-year period from 2001 to 2005. Two hundred and twenty intra-arterial thrombolytic procedures were carried out in 195 patients (46% women), median age 73 years. Haemorrhagic complications were recorded in 72 procedures (33%), of which 13 were discontinued. Haemorrhage at the introducer and distant sites occurred in 53 and 32 procedures, respectively. Thrombolysis for occluded synthetic grafts was associated with higher risk of haemorrhage (P = 0.043). The platelet count was lower (P = 0.017) and the dose of alteplas higher (P = 0.041) in bleeders than in non-bleeders. Age was not associated with haemorrhage (P = 0.30). Two patients died during thrombolysis, one of them due to intracerebral haemorrhage. The grade of thrombolysis was an independent predictor of both in-hospital amputation (P < 0.001; OR 3.5 [95% CI 2.1-5.8]) and mortality (P = 0.021; OR 3.0 [95% CI 1.2-7.9]). The in-hospital amputation-free survival rate was 85% (188/220). Haemorrhage associated with thrombolysis is common, but does seldom require discontinuation of treatment. Insertion of introducers for local thrombolysis through synthetic grafts, lower platelet count and higher alteplas dose were found to be risk factors for haemorrhage. An algorithm for clinical management of haemorrhage has been proposed. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Amputation, Haemorrhage, Lower limb ischemia, Mortality, Thrombolysis
in
Journal of Thrombosis and Thrombolysis
volume
31
issue
2
pages
226 - 232
publisher
Springer
external identifiers
  • scopus:79951726403
  • wos:000286467400013
  • pmid:20848161
ISSN
1573-742X
DOI
10.1007/s11239-010-0520-2
language
English
LU publication?
yes
id
ae774686-5552-4151-8275-f084f41b0a74 (old id 4779010)
date added to LUP
2016-01-27 12:59:14
date last changed
2017-10-22 04:03:47
@article{ae774686-5552-4151-8275-f084f41b0a74,
  abstract     = {Assessment of clinical risk factors for haemorrhagic complications in patients undergoing intra-arterial thrombolysis for lower limb ischaemia. Retrospective reviews of consecutive patients subjected to intra-arterial thrombolysis due to lower limb ischemia at the Vascular Center, Malmö University Hospital, during a 5-year period from 2001 to 2005. Two hundred and twenty intra-arterial thrombolytic procedures were carried out in 195 patients (46% women), median age 73 years. Haemorrhagic complications were recorded in 72 procedures (33%), of which 13 were discontinued. Haemorrhage at the introducer and distant sites occurred in 53 and 32 procedures, respectively. Thrombolysis for occluded synthetic grafts was associated with higher risk of haemorrhage (P = 0.043). The platelet count was lower (P = 0.017) and the dose of alteplas higher (P = 0.041) in bleeders than in non-bleeders. Age was not associated with haemorrhage (P = 0.30). Two patients died during thrombolysis, one of them due to intracerebral haemorrhage. The grade of thrombolysis was an independent predictor of both in-hospital amputation (P &lt; 0.001; OR 3.5 [95% CI 2.1-5.8]) and mortality (P = 0.021; OR 3.0 [95% CI 1.2-7.9]). The in-hospital amputation-free survival rate was 85% (188/220). Haemorrhage associated with thrombolysis is common, but does seldom require discontinuation of treatment. Insertion of introducers for local thrombolysis through synthetic grafts, lower platelet count and higher alteplas dose were found to be risk factors for haemorrhage. An algorithm for clinical management of haemorrhage has been proposed.},
  author       = {Kuoppala, Monica and Åkeson, Jonas and Svensson, Peter and Lindblad, Bengt and Franzén, Sofia and Acosta, Stefan},
  issn         = {1573-742X},
  keyword      = {Amputation,Haemorrhage,Lower limb ischemia,Mortality,Thrombolysis},
  language     = {eng},
  number       = {2},
  pages        = {226--232},
  publisher    = {Springer},
  series       = {Journal of Thrombosis and Thrombolysis},
  title        = {Risk factors for hemorrhage during local intra-arterial thrombolysis for lower limb ischaemia},
  url          = {http://dx.doi.org/10.1007/s11239-010-0520-2},
  volume       = {31},
  year         = {2011},
}