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Urokinase infusion protocol

Harm P Ebben, Johanna H Nederhoed, Rutger J Lely, Willem Wisselink, Kakkhee Yeung
INTRODUCTION: Acute peripheral arterial occlusions can be treated with intra-arterial catheter-directed thrombolysis as an alternative to surgical thromboembolectomy. Although less invasive, this treatment is time-consuming and carries a significant risk of haemorrhagic complications. Contrast-enhanced ultrasound using microbubbles could accelerate dissolution of thrombi by thrombolytic medications due to mechanical effects caused by oscillation; this could allow for lower dosages of thrombolytics and faster thrombolysis, thereby reducing the risk of haemorrhagic complications...
August 11, 2017: BMJ Open
Jung Tack Son, Sun Young Min, Jae Il Kim, Pyong Wha Choi, Tae Gil Heo, Myung Soo Lee, Chul-Nam Kim, Hong-Yong Kim, Seong Yoon Yi, Hye Ran Lee, Young-Nam Roh
PURPOSE: The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis. MATERIALS AND METHODS: We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014...
December 2014: Vascular Specialist International
Harm P Ebben, Johanna H Nederhoed, Jeroen Slikkerveer, Otto Kamp, Geert W J M Tangelder, René J P Musters, Willem Wisselink, Kak K Yeung
BACKGROUND: The addition of local ultrasound (US) with a contrast agent to standard intra-arterial thrombolysis can accelerate the thrombolytic treatment of stroke and myocardial infarction. The contrast agent consists of microsized gas-filled bubbles that collapse when exposed to US, causing destabilization of the clot and making the clot surface more susceptible to fibrinolytics. In this study, we investigated the effect of additional US and microbubbles on standard low-dose intra-arterial thrombolysis in a porcine model of extensive peripheral arterial occlusion...
August 2015: Journal of Vascular Surgery
Masatoshi Motohashi, Akira Adachi, Ko Takigami, Keishu Yasuda, Masayuki Inoue, Shigeyuki Sasaki, Yoshiro Matsui
To prevent pulmonary embolism due to deep venous thrombosis (DVT), we have treated 611 patients undergoing orthopedic surgery of the lower extremities with our protocol including pre- and postoperative ultrasonic venous screening and anticoagulant therapy if necessary. A total of 118 patients (19.3%) developed DVT. Among demographic and clinical factors, the site of operation (knee joint surgery: odds ratio 5.17), age (>60: odds ratio 3.91), and operation time (>120 minutes: odds ratio 4.52) were identified as significant risk factors of development of DVT...
2012: Annals of Vascular Diseases
L Shavit, M Lifschitz, J Plaksin, T Grenader, I Slotki
BACKGROUND: Catheter thrombosis is common and results in inadequate dialysis treatment and, frequently, in catheter loss. Since dialysis treatment runs on a strict schedule, occluded catheters need to be restored in a timely and cost effective manner. We present a new shortened protocol of urokinase infusion that allows hemodialysis to be performed within 90 minutes. METHODS: To chronic hemodialysis patients, who developed complete catheter occlusion, urokinase was infused simultaneously through both lumens of the catheter (125,000 units to each lumen) over 90 minutes...
October 2010: Clinical Nephrology
S Tamatani, O Sasaki, T Koizumi, K Nishimaki, Y Ito, T Koike, S Takeuchi, R Tanaka
Fibrinolytic therapy for acute ischaemic stroke has been investigated in several clinical trials, with various protocols. This retrospective study was undertaken to evaluate the efficacy and limitation of local intra-arterial fibrinolytic therapy using urokinase (UK) in patients with acute middle cerebral artery occlusion. Fifty patients were treated with local intra-arterial fibrinolytic therapy within six hours after onset of symptoms. The median National Institutes of Health Stroke Scale (NIHSS) score was 17 (range, 6 to 28)...
June 30, 2000: Interventional Neuroradiology
Nathalie Demoulin, Eric Goffin
BACKGROUND: Coagulase-negative staphylococcus (CoNS) is responsible for cases of refractory and relapsing peritonitis in peritoneal dialysis (PD) patients, probably by biofilm formation on the catheter. The ISPD recommends catheter removal in such cases. Urokinase has been used to dissolve the biofilm lining the PD catheter, thus favoring antibiotic efficacy. Rifampicin has shown its efficacy in penetrating CoNS biofilm. METHODS: We defined persisting asymptomatic CoNS dialysate infection as a peritonitis episode with clinical improvement within 48 hours and dialysate clearing, but with persisting positive dialysate cultures...
September 2009: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
Albert Power, Neill Duncan, Seema K Singh, Wendy Brown, Elizabeth Dalby, Claire Edwards, Kathleen Lynch, Virginia Prout, Tom Cairns, Megan Griffith, Adam McLean, Andrew Palmer, David Taube
BACKGROUND: Sodium citrate has antibacterial and anticoagulant properties that are confined to the catheter when used as a catheter lock. Studies of its use as a catheter lock have suggested its efficacy in preventing infection and bleeding complications compared with sodium heparin. STUDY DESIGN: Open-label randomized controlled trial of 2 catheter locks to examine the hypothesis that sodium citrate catheter locks will reduce catheter-related bacteremia and exit-site infection...
June 2009: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Daniel Hänggi, Julia Liersch, Bernd Turowski, Mei Yong, Hans-Jakob Steiger
OBJECT: The authors of recent publications have suggested that a combination of cisternal irrigation and head-shaking therapy might reduce cerebral vasospasm after subarachnoid hemorrhage (SAH) and therefore improve outcome. The authors undertook this prospective nonrandomized Phase II study to analyze the effect of enhanced washout by lumboventricular irrigation in combination with head motion (lateral rotational therapy) on the clot clearance (CC) rate, development of cerebral vasospasm, and clinical outcome...
June 2008: Journal of Neurosurgery
E Martínez-Fernández, A González, A Gil-Peralta, J R González-Marcos, A Mayol Deyá
INTRODUCTION: In addition to the thrombolytic agents, mechanical devices are being used in intraarterial procedures in acute stroke patients. The intervention protocol and outcomes of intraarterial procedures performed in the Hospital Virgen del Rocío in 2003-2004 are described. METHODS: The results in each arterial occlusion site and case-control study of the middle cerebral artery (MCA), the placebo group in PROACT II study (Prolyse in Acute Cerebral Thromboembolism II) as historic control group, are described...
January 2008: Neurología: Publicación Oficial de la Sociedad Española de Neurología
David M Widlus, Ari I Salis
GOALS: To present the results of a new protocol for provocative visceral arteriography. BACKGROUND: Acute lower gastrointestinal hemorrhage (LGIB) usually stops spontaneously. In the absence of an identifiable source, if bleeding is recurrent, provocative visceral arteriography has been advocated for diagnosis. Prior studies using Streptokinase, Urokinase, or tissue plasminogen activator have reported a 33% to 37.5% rate of identifying the site of hemorrhage. STUDY: We report a retrospective analysis of 9 patients in whom provocative visceral arteriography was performed using a new protocol with Reteplase as the fibrinolytic agent...
October 2007: Journal of Clinical Gastroenterology
A Oufquir, J Bakhach, B Panconi, J-C Guimberteau, J Baudet
At the end of the seventy, we saw the reconstructive microsurgery developed to such an extent that it became a new and an independent surgical specialty. The development of the microsurgical instrumentation and the description of the surgical anatomy allowed the application of this technology to the most complex plastic reconstructions and particularly to the replantation of the amputated digits, especially the very distal digital amputations. Nowadays, the indications of digital replantation are well-defined according to numerous parameters conditioning the anatomical result and the functional outcome...
December 2006: Annales de Chirurgie Plastique et Esthétique
J Davies, J Casey, C Li, A V Crowe, P McClelland
Urokinase and streptokinase are commonly used thrombolytic agents for obstructed central venous catheters. Although proven to be efficacious, these agents have the potential to induce fibrin breakdown and streptokinase cannot be used repeatedly due to its allergenic nature. Documented evidence suggests that urokinase is safe and effective (> 70% efficacy for catheter installation) however further evidence points to tissue-type plasminogen activator (rt-PA) achieving as much as 98% success. This study reports on the safety and efficacy of alternative catheter thrombolysis, namely rt-PA and evaluates the efficacy of rt-PA...
April 2005: EDTNA/ERCA Journal
Dong Joon Kim, Dong Ik Kim, Seo Hyun Kim, Kyung Yeol Lee, Ji Hoe Heo, Sang Won Han
The outcome of patients who show no early response to intravenous (i.v.) tissue plasminogen activator (tPA) therapy is poor. The objective of this study was to evaluate the feasibility of rescue localized intra-arterial thrombolysis (LIT) therapy for acute ischemic stroke patients after an early non-responsive i.v. tPA therapy. Patients with proximal MCA occlusions who were treated by LIT (n = 10) after failure of early response [no improvement or improvement of National Institute of Health Stroke Scale (NIHSS) scores of < or = 3] to i...
August 2005: Neuroradiology
J Davies, J Casey, C Li, A V Crowe, P McClelland
PROBLEM: Urokinase and streptokinase are commonly used thrombolytic agents for obstructed central venous catheters. Although proven to be efficacious, these agents have the potential to induce fibrin breakdown and streptokinase cannot be used repeatedly because of its allergenic nature. Published evidence suggests that Urokinase is safe and effective (>70% efficacy for catheter installation) and that Tissue-type plasminogen activator (rt-PA) can achieve as much as 98% success. OBJECTIVE: To describe our experience with and our protocol for the use of rt-PA as an alternative agent for catheter thrombolysis...
December 2004: Journal of Clinical Pharmacy and Therapeutics
I Fackler-Schwalbe, B Schwalbe, M Epple, A Becker, L Prügl, W D Gassel, D Stoffels, T Südhoff
Folinic acid-modulated 5-FU regimens are standard elements in several chemotherapy combinations like FOLFIRI, FOLFOX or AIO-regimen in the palliative treatment of patients with gastrointestinal cancer. When the simultaneous mixed infusion of 5-FU and calcium-folinic acid (Leucovorin) was authorized by the BfArM in 2002, we introduced this application regimen in the treatment of our cancer patients. 19 patients (AIO-regimen [5], FOLFIRI [12] and FOLFOX [2]) received a simultaneously mixed infusion of calcium-folinic acid and 5-FU over 24 hours with a total of 110 applications...
May 2004: Wiener Medizinische Wochenschrift
H-R Bruch, M Esser
BACKGROUND: The treatment of colorectal cancer with administration of a 2-h infusion of calcium folinate followed by a 24-h infusion of 5-fluorouracil (5-FU) is a standard therapy. Based on newly published data we have applied an infusion of both compounds, 5-FU and calcium folinate, mixed together in an ambulatory pump. PATIENT AND METHODS: We report on a patient suffering from metastatic rectal cancer. After first and second line chemotherapy we started third line chemotherapy consisting of calcium folinate (1,000 mg) and 5-FU (4,000 mg) mixed together in a total volume of 240 ml in an ambulatory pump and administered over a period of 24 h...
October 2003: Onkologie
G Wang, W Lu, Q Xia, B Mao, L Wang, T Li, L Jiang
Embolism of the superior mesenteric artery (SMA) is a rare disorder. To explore the selective criteria of local thrombolysis, evaluate its efficacy and discuss the therapeutic protocol of SMA embolism, a retrospective case control study was undertaken. Sixteen cases were divided into two groups: nine cases (group A) from May 1995 to April 1999 were given traditional treatment, while seven cases (group B) from November 1999 to June 2002 received comprehensive therapy including local thrombolysis. The local thrombolytic treatment was performed without procedure-related complications and the embolus was successfully lysed in four patients...
September 2003: International Journal of Clinical Practice
F Stagnitti, M Mongardini, M Coletti, S M Calderale, S Ribaldi, P F Salvi, F Schillaci, L Bresadola
Superior vena cava syndrome is due to an intrinsic or extrinsic caval obstruction that evolves in acute or subacute way with distinctive clinical feature such as respiratory symptoms and venous stasis. Since 1998 we have treated three cases of spontaneous superior vena cava thrombosis in neoplastic patients who underwent several infusion of chemotherapy, respectively for a breast, uterine and rectum cancer. All patients was female, 52, 58 and 70 years old. The first two cases was treated with locoregional thrombolysis by infusing Urokinase 50,000 UI/h during 24 hours and Urokinase 50,000 UI/h during 12 h the third one...
August 2002: Il Giornale di Chirurgia
Matthew J Baker, Steven Brem, Stephanie Daniels, Beverly Sherman, Surasak Phuphanich
Sodium phenylbutyrate is a biological-response modifier that acts as a dose-dependent inhibitor of glioma cell proliferation, migration, and invasiveness in vitro, possibly by inhibition of urokinase and c-myc pathways. Despite its biological activity in vitro, there have not been any prior reports of efficacy in the treatment of human malignant gliomas. We report a 44-year-old female with a recurrent, multicentric, malignant glioma who experienced a durable remission lasting more than four years. The patient initially presented with seizures caused by a biopsy-proven anaplastic astrocytoma of the frontal lobe...
September 2002: Journal of Neuro-oncology
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