Comparative study of short-term outcome of accelerated dose thrombolytic therapy versus standard dose thrombolytic therapy in cases of acute lower limb ischemia

Aim: Acute limb ischemia is a serious disorder that threatens a patient’s limbs and even life. Rapid and effective treatment is needed to maintain blood flow. This study aims to compare the short-term outcome of catheter-directed thrombolytic therapy infusion in cases of acute thrombotic lower limb ischemia using the standard regimen versus accelerated dose thrombolytic therapy. 

Material and Methods: Forty-two patients with acute thrombotic ischemia Rutherford 1 and 2a, with a mean age of 55 years, were included, of whom 31 were males. All patients received thrombolytic therapy and were divided equally into two groups. The (STT) group received standard dose thrombolytic therapy, and the (ATT) group received accelerated dose thrombolytic therapy. Post-intervention, restoration of flow, limb salvage, patency, amputations, morbidities, and mortalities were evaluated.

Results: In 57% of the ATT group, successful thrombus lysis was performed versus 71% in the STT group, showing a statistically insignificant difference. The culprit arterial lesion was found in 79% of all cases. At one-month follow-up, the patency rate of ATT cases was 52%, and the failure rate was 38% versus 77% and 6% in the STT group, respectively. One-month patency showed a statistically significant difference (p<0.026). The amputation rate at one-month follow-up was 5% in the ATT group versus 6% in the STT group. Three patients died: Two from the STT group and one from the ATT group.

Conclusion: Compared to ATT, using STT results in better short-term outcomes regarding patency and limb salvage rates. However, ATT provides the benefit of decreased risk of bleeding and access site hematoma.