Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: EC:3.4.21.68 (tissue plasminogen activator)
 11,311 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thrombolysis is an essential first step in the surgical management of acute spontaneous axillo-subclavian vein thrombosis (Paget-Schroetter syndrome). During the past decade, Urokinase became the standard thrombolytic agent until temporarily withdrawn from the market. In its absence, recombinant tissue plasminogen activator (r-TPA) was introduced and attained widespread use. A direct comparison of the efficacy of these two agents in this setting has not been published. The goal of this study is to compare thrombolytic agents in the management of acute Paget-Schroetter syndrome. This study is based on a retrospective review of 30 consecutive patients (15 Urokinase, 15 r-TPA) who underwent thrombolysis and surgery for Paget-Schroetter syndrome. Our hypothesis is that thromblysis with Urokinase and r-TPA is equally safe and effective in management of acute axillo-subclavian vein thrombosis. Primary outcome measures include success of lysis, hemorrhagic complications, subclavian vein patency at completion of treatment, resolution of presenting symptoms, and restitution of normal arm function. There were no significant differences in the primary outcome measures: success of lysis, hemorrhagic complication, perioperative bleeding, and subclavian vein patency. Time to completion of lysis was slightly shorter with r-TPA (but this did not achieve statistical significance). One patient in each group suffered incomplete lysis of thrombus. One patient in the r-TPA group required transfusion due to surgical bleeding. No patient received transfusion due to thrombolysis-related bleeding. All patients experienced resolution of symptoms and return of arm function. Our findings support the hypothesis that Urokinase and r-TPA are similarly safe and successful for management of spontaneous axillo-subclavian vein thrombosis. Given these results, secondary factors such as cost, availability, and familiarity with the different agents will likely determine the agent of choice.
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PMID:Comparison of retavase and urokinase for management of spontaneous subclavian vein thrombosis. 1734 54

INTRODUCTION Paget-Schroetter syndrome, or effort thrombosis, refers to a deep venous thrombosis in an upper extremity. It is most commonly located in the axillary or subclavian veins and is associated with vigorous repetitive movements and anatomic abnormalities. CASE PRESENTATION This case study describes an 18-year-old Division 1 soccer player who presented with worsening axillary swelling and pain. He was found to have subclavian stenosis at the level of the thoracic inlet between the clavicle and first rib, with deep venous thrombosis in his right axillary, subclavian, proximal brachial, and basilic veins. It was diagnosed with ultrasound and confirmed with venography. He was treated initially with enoxaparin and warfarin before having mechanical thrombolysis, balloon venoplasty, infusion of tissue plasminogen activator, and a right first rib resection. CONCLUSION As Paget-Schroetter syndrome is rare, early recognition and management leads to fewer long-lasting sequelae and less morbidity. Left untreated, it can result in pulmonary embolism and residual upper extremity obstruction.
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PMID:Soccer player with unusual right shoulder and arm pain and swelling. 3259 86