Comparison of tPA and urokinase for peripheral arterial thrombolysis

The comparison of thrombolytic drugs for treatment of peripheral arterial occlusions has important clinical and practical implications. Forty-five patients were randomized to receive recombinant tissue plasminogen activator (tPA) (n = 23) or urokinase (UK) (n = 22) All patients had lower extremity ischemia with occlusions involving the common femoral or more distal arteries or a bypass graft in the lower extremity. All were randomized after arteriography, but before thrombolytic catheter placement. Forty of the forty-five patients (89% ) had successful thrombolysis; 21 of 23 (91%) of those treated with tPA and 19 of 22 patients (86%) treated with UK. No differences were identified in success of treating native arteries versus bypass grafts, tPA versus UK, or in 30 day patency. There was a significantly shorter duration of infusion for tPA vs UK; 5.8 hours vs 18.7 hours and a lower drug charge for tPA by 76%. Six of the forty-five patients (13.3%) had a major complication. There was no differences between tPA and UK in number or severity of the complications. tPA and UK possess similar capabilities to lyse thrombi in native arteries or bypass grafts. Complications do not differ. There is a significant cost savings and a reduction in infusion time when tPA is used.