Treament of Deep Vein Thrombosis with Alteplase

深静脉血栓形成(DVT)的标准治疗方法是抗凝。虽然这通常会阻止血栓的进展，但血栓必须通过自然过程溶解，这需要几周到几个月的时间，通常会留下永久性的静脉损伤。为了更快地清除血栓和保护静脉功能，我们进行了一种直接注射到血栓中的溶栓剂-重组组织型纤溶酶原激活剂(rtPA，Alteplase)的试验。这种治疗是有效的，而且只与轻微的不良反应有关。然而，由于出血的风险，rtPA仅用于被认为出血风险非常低的患者。为了减少出血的风险，我们现在使用的rtPA剂量要低得多，它也可能与前一剂量一样有效，甚至更有效，因为它可以避免纤溶酶原耗尽。到目前为止，按照这个方案，我们只治疗了一名患者。她只接受了分布在3个疗程中的22毫克rtPA(而早期方案中最多给予150毫克)。她的血栓广泛溶解，口服抗凝治疗仍无症状。该方案被批准用于21名患者。

The standard treatment for deep vein thrombosis (DVT) is anticoagulation. Although this usually stops thrombus progression, the clot must resolve by natural processes, which take weeks to months and often leave permanent venous damage. In an effort to remove thrombus more quickly and preserve venous function we have conducted trials of a thrombolytic agent, recombinant tissue plasminogen activator (rtPA, Alteplase), which is injected directly into the thrombi. This treatment has been effective and associated with only minor adverse events. However, because of the risk of bleeding rtPA has been given only to patients considered to have a very low risk for hemorrhage. To reduce the risk of bleeding we are now using a much lower dose of rtPA, which may also be just as effective or even more so than the previous dose because it may avoid plasminogen depletion. So far on this protocol we have treated only one patient. She received only 22 mg of rtPA distributed over 3 treatment sessions (compared with up to 150 mg given in earlier protocols). Her thrombi lysed extensively, and she has continued to be asymptomatic on oral anticoagulation. The protocol is approved for 21 patients.