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A Review of Thrombolysis in Venous Thromboembolism With an Analysis of Alteplase Admixture Stability

  • Pharmacology Care (J Fanikos, Section Editor)
  • Published:
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Abstract

Purpose of Review

Our objective is to review important and recent clinical trials of systemic and local thrombolysis for acute venous thromboembolism (VTE).

Recent Findings

While anticoagulation is the cornerstone of VTE treatment, systemic thrombolysis is recommended for the highest risk pulmonary embolism (PE) patients who present with hypotension and also have a low bleeding risk. Utilization of low-dose, catheter-directed thrombolytic administration with or without ultrasound energy may minimize bleeding risk beyond systemic thrombolysis.

Summary

Venous thromboembolism (VTE), including deep-vein thrombosis (DVT) and pulmonary embolism (PE), is a common cardiovascular disease. Current guidelines recommend anticoagulation over catheter-directed thrombolysis in acute DVT primarily due to the limitations of available data. Clinical trial information is conflicting on whether catheter-directed thrombolysis reduces rates of post-thrombotic syndrome and improves rates of vessel patency. Stability data on alteplase in the catheter-directed setting are limited. Our mass spectrometry analysis indicates that a wide range of alteplase concentrations are stable for at least 24 h. These data can reassure pharmacists, nurses, and physicians that alteplase remains stable during infusion durations utilized in catheter-directed thrombolysis. Individual facilities can tailor their alteplase preparation to meet their own institutional needs.

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Funding

No specific funding was received for this study.

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Authors and Affiliations

  1. Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA

    Benjamin Hohlfelder, Kathleen Marquis, John Fanikos, Leo F. Buckley & Ahlam Alghamdi

  2. Thrombosis Research Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA

    Gregory Piazza & Samuel Z. Goldhaber

Authors
  1. Benjamin Hohlfelder
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  2. Kathleen Marquis
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  3. John Fanikos
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  4. Leo F. Buckley
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  5. Ahlam Alghamdi
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  6. Gregory Piazza
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  7. Samuel Z. Goldhaber
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Corresponding author

Correspondence to Leo F. Buckley.

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Conflict of Interest

John Fanikos reports consultancy activities for Genentech, Inc. Gregory Piazza reports receipt of grants from BTG Interventional Medicine Ltd. Samuel Goldhaber reports grants from BTG/EKOS, BiO2 Medical, Boehringer Ingelheim, BMS, Daiichi, Janssen, personal fees from Agile, Bayer, Boehringer Ingelheim, BMS, Daiichi, eXIthera, Janssen, Portola, and Soleno.

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Hohlfelder, B., Marquis, K., Fanikos, J. et al. A Review of Thrombolysis in Venous Thromboembolism With an Analysis of Alteplase Admixture Stability. Curr Emerg Hosp Med Rep 6, 54–61 (2018). https://doi.org/10.1007/s40138-018-0156-7

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  • DOI: https://doi.org/10.1007/s40138-018-0156-7

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