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Efficacy and safety of catheter-directed thrombolytic therapy of alteplase and urokinase for the treatment of deep venous thrombosis: a Meta-analysis

Published on Sep. 30, 2022Total Views: 1087 timesTotal Downloads: 545 timesDownloadMobile

Author: Hong-Yan LI 1 Hai-Shan WANG 2 Yong-Bo WANG 3 Xiu-Qing SHI 4 Si-Yu YAN 3 Tao WANG 5 Xiang-Ying REN 3 Ying-Hui JIN 3

Affiliation: 1. Department of Pharmacy, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China 2. Department of Intensive Care Unit, Yantai YEDA Hospital, Yantai 264000, Shandong Province, China 3. Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China 4. Department of Medical Oncology, Qindao University Medical College Affiliat-ed Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China 5. Department of Vascular Surgery, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China

Keywords: Alteplase Urokinase Deep vein thrombosis Systematic review Meta-analysis

DOI: 10.12173/j.issn.1004-5511.202207035

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Objective To systematically review the effectiveness and safety of catheter-directed thrombolytic therapy (CDT) using alteplase and urokinase in the treatment of deep venous thrombosis (DVT) in the lower extremities. 

Method  PubMed, The Cochrane Library, Web of Science, Embase, WanFang Data, CNKI and SinoMed databases were searched electronically to collect randomized clinical trials on CDT using alteplase and urokinase in the treatment of DVT in the lower extremities from incep-tion of the databases to December 2021. Two reviewers independently screened literature, extracted data, and assessed the risk of bias in included studies: a meta-analysis was performed using RevMan 5.4 software. 

Result  A total of 7 clinical trials involving 598 patients were included. The results of the me-ta-analysis showed that there was no statistically significant difference between alteplase and urokinase in the clinical effectiveness rate [RR=1.07, 95%CI(0.91,1.25), P=0.43] and thrombolysis rate [RR=1.08, 95%CI(0.99,1.16), P=0.07]; the thrombolytic time of alteplase was shorter than that of urokinase [MD=-1.12, 95%CI(-1.93,-0.31), P=0.007]; there was no statistically significant difference between al-teplase and urokinase in the incidence of minor bleeding [RR=0.73, 95%CI(0.27,1.98), P=0.54].  

Conclusion  The effectiveness and safety of CDT of alteplase and urokinase in the treatment of DVT in the lower extremities and the risk of bleeding are comparable, but alteplase achieved thrombolysis in a shorter time than urokinase. The above conclusions are limited by the quantity and quality of included studies and need to be verified by more high-quality research.

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