Treament of Deep Vein Thrombosis with Alteplase

深静脉血栓形成（DVT）的标准治疗是抗凝治疗。虽然这通常会阻止血栓进展，但凝块必须通过自然过程解决，这需要数周到数月的时间，并且通常会留下永久性的静脉损伤。为了更快地清除血栓并保护静脉功能，我们进行了直接注射到血栓中的血栓溶解剂重组组织纤溶酶原激活剂（rtPA，阿替普酶）的试验。这种治疗是有效的，只与轻微的不良事件有关。然而，由于出血风险，rtPA仅用于出血风险极低的患者。为了降低出血风险，我们现在使用低得多的rtPA剂量，这也可能与以前的剂量一样有效，甚至更有效，因为它可以避免纤溶酶原耗竭。到目前为止，我们只治疗了一名患者。她仅接受了22 mg rtPA，分布在3个治疗阶段（与早期方案中给予的高达150 mg相比）。她的血栓广泛溶解，口服抗凝剂后仍无症状。该方案已获批用于21例患者。

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.