Thrombolytic therapy of deep venous thrombosis (DVT)

POSTER SESSION 6: VENOUS THROMBOSIS THURSDAY, June 5, 1986 Abstract No. 156 - Abstract No. 169 156 SUBCUTANEOUS ENOXAPARIN AS ANTICOAGULANT THERAPY IN ACUTE PULMONARY EMBOLISM I-N MAN. Y. tlUf3, M. GOUAULT-HEILMANN, 1. CIGARINI, M. PERRIER, S. BEN LAKHAL. Intenslve Care Unlt - Haematology Laboratory. Henrl Mondor Hospital - 94010 CRETEIL (FRANCE) Standard unfractionated heparln (UH) Is effective In the treatment of acute pulmonary embolism (APE1 but may lead to slgnlflcant side-effects (bleeding compllcatlons and thrombocytopenla). ExperImental studies has shown that a lower risk of deleterlous effects could be expected from the use Of Iow molecular welght heparln (LWH) fractions. The alm of thls study was to appreciate the efficacy and tolerance of a LMWH fraction given subcutanenously In APE. Material and kthodsEleven patients (7 females, 4 males, mean age 58 years, range 34-75 years1 with APE documented by concordant results of angloscan and pulmonary anglography were studled. Pulmonary vascular obstructlon (PVO) was evaluated uslng the Miller’s Index. APE was secondary to lower limbs (7 patIentsI and upper limbs thrombophlebltls (2 patients) as documented by venography. A LM#H fraction (Enoxaparln, Pharmuka, Rhone-Poulenc Lab.) was admlnlstered 20 days at an lnltlal dosage of 1 mg/kg/day. Enoxaparln dosage subcutaneously twice dally durlng was subsequently adjusted according to the antl-Xa actlvlty in order to obtaln an anti-Xa actlvlty between 0.2 to 0.6 Ill/ml at the peak by reference to the antl-Xa actlvlty achieved with UH In such patlents. The followlng blologlcal parameters were evaluated : peak (3 hours after lnfectlon) and residual (12 hours after InfectIon anti-Xa and antl-lla actlvltles (amldolytlc APTT, AT III level, hemoglobin level, platelet count. Follow up of antlcoagulant methods), therapy was evaluated on cllnlcal pattern and assessed by successive angloscans (day 10 and day 20) and by pulmonary anglography (day 20). Results and ammmts. lnltlal anglographlc PVO was 45f13 8. For a mean dosage of 1.80 mg/kg/day (ranging from 1.34 to 2.22 mg/kg/day) all patlents except one had an improvement In pulmonary (PVO = 22 f 11 % at day 20). Only one perfuslon on angloscans and on pulmonary anglography patlent exhlblted a recurrence of PE at time of an underdosage. No bleeding compIIcations were noted. Mean peak and residual antl-Xa actlvltles were 0.41tO.09 and 0.15f0.06 Ill/ml respectively. No slgnlflcant change were noted In APTT, AT III level, hemoglobin level and platelet count. In thls prellmlnary study, subcutaneous Enoxaparln proved an effective antlthrcmbotfc therapy durln the first 20 days after APE and the tolerance was good In al I patients. One recurrence of P2 was observed In relation to an underdosage.

157 THROMBOLYTIC THERAPY OF DEEP VENOUS THROMBOSIS (OVT) Seyfert, U .T., Hauck, W. , Albert, F .W. Medizin. Klinik III, Stadt. Krankenhaus, 6750 Kaiserslautern, FRG. Fibrinolytic therapy of OVT with streptase and/or urokinase was carried out in 49 patients with OVT. In 40 % of 49 patients with OVT a complete thrombolysis and in 14 % a partial thrombolysis could be attained. Sequential streptase/urokinase therapies led merely to partial thrombolysis in our patient pool. Hemorrhagic complications making transfusions necessary or resulting in death, as well as fatal anaphylactic reactions did not occur. Closely spaced laboratory controls are important for hemorrhage prophylaxis (macroscopic hematuria, abdominal bleeding, bleeding from injection sites) as well as for prevention of rethrombosis. Development of a postthrombotic syndrome following successful lysis therapy is improbable. Thrombophilic diagnostic procedures must be persued in each case of thromboembolism. We were able to cite risk factors (oral contraceptives, traumas/ operations - especially emergency surgery and sectio caesarea -, hereditary coagulation defects) in about 40 % of the cases. Long-term anticoagulation was administered to one patient with antithrombin III-deficiency as well as in cases of lack of release of plasminogen activator from venous endothelium. 79