Thrombolysis of peripheral arterial and graft occlusions: improved results using high-dose urokinase.

Ninety-three thromboembolic occlusions of peripheral arteries or grafts in 85 patients were treated with high-dose urokinase by direct intraarterial infusion. Urokinase was infused at 4000 IU/min until antegrade blood flow was reestablished and then at 1000 or 2000 IU/min until clot lysis was completed. Of the 93 infusions, 75 (81%) resulted in clinical improvement. The infusion therapy was incomplete in nine patients. The mean duration of the 84 completed infusions was 18 +/- 20 hr, the incidence of complete clot lysis was 83%, and the incidence of clinical improvement was 89%. Significant bleeding, requiring transfusion, occurred during or after four of the urokinase infusions (4%). Other complications included distad clot migration, thrombus formation on the catheter, revascularization phenomena, oliguria, skin rash, pseudoaneurysm, balloon rupture during angioplasty, and vascular spasm. There were no instances of drug resistance or adverse drug reactions. These results indicate that an initially high-dose urokinase regimen accomplishes more rapid recanalization, a higher incidence of total clot lysis, and produces fewer complications than the standard low-dose streptokinase regimen.