Blood Coagulation Disorders ; drug therapy ; Child ; Child, Preschool ; Drug Therapy, Combination ; Female ; Heparin ; administration & dosage ; Humans ; Male ; Nephrotic Syndrome ; blood ; complications ; urine ; Urokinase-Type Plasminogen Activator ; administration & dosage

OBJECTIVE: To explore the curative effect of combining exchange of cerebrospinal fluid with small dose of urokinase injection for the treatment of subarachnoid hemorrhage (SAH). METHODS: One hundred thirty-four SAH patients diagnosed by CT or MRI and lumbar puncture were randomly divided into two groups: 68 patients in the treatment group were given exchange of cerebrospinal fluid and small dose of urokinase injection; 66 patients in the control group were treated with exchange of cerebrospinal fluid. The main complications, the neurological deficit scale and curative effect of the two groups were compared. RESULTS: Complications about cerebral vasospasm and hydrocephalus were fewer than those in the conventional therapeutic group (P < 0.05), and there was no significant difference in the incidence of rebleeding between the two groups (P > 0.05). The neurological deficit scale in the treatment-group was significantly lower than that in conventional therapeutic group (P < 0.01). There was obvious difference the curative effect in the two groups (P < 0.05). CONCLUSION Combining exchange of cerebrospinal fluid with small dose of urokinase injection is an effective method for treating SAH, and it can improve the survival rate and life quality of SAH patients.
Adult ; Aged ; Cerebrospinal Fluid ; Drainage ; methods ; Female ; Humans ; Injections, Spinal ; Male ; Middle Aged ; Subarachnoid Hemorrhage ; therapy ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; administration & dosage

PURPOSE: The severity of a stroke cannot be described by widely used prehospital stroke scales. We investigated the usefulness of the Kurashiki Prehospital Stroke Scale (KPSS) for assessing the severity of stroke, compared to the National Institutes of Health Stroke Scale (NIHSS), in candidate patients for intravenous or intra-arterial thrombolysis who arrived at the hospital within 6 hours of symptom onset. MATERIALS AND METHODS: We retrospectively analyzed a prospective registry database of consecutive patients included in the Emergency Stroke Therapy program. In the emergency department, the KPSS was assessed by emergency medical technicians. A cutoff KPSS score was estimated for candidates of thrombolysis by comparing KPSS and NIHSS scores, as well as for patients who actually received thrombolytic therapy. Clinical outcomes were compared between patients around the estimated cut-off. The independent predictors of outcomes were determined using multivariate logistic regression analysis. RESULTS: Excellent correlations were demonstrated between KPSS and NIHSS within 6 hours (R=0.869) and 3 hours (R=0.879) of hospital admission. The optimal threshold value was a score of 3 on the KPSS in patients within 3 hours and 6 hours by Youden's methods. Significant associations with a KPSS score > or =3 were revealed for actual intravenous administration of tissue plasminogen activator (IV-tPA) usage [odds ratio (OR) 125.598; 95% confidence interval (CI) 16.443-959.368, p<0.0001] and actual IV-tPA or intra-arterial urokinase (IA-UK) usage (OR 58.733; 95% CI 17.272-199.721, p<0.0001). CONCLUSION: The KPSS is an effective prehospital stroke scale for identifying candidates for IV-tPA and IA-UK, as indicated by excellent correlation with the NIHSS, in the assessment of stroke severity in acute ischemic stroke.
Administration, Intravenous ; Confidence Intervals ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; Emergency Service, Hospital ; Humans ; Logistic Models ; Methods ; National Institutes of Health (U.S.) ; Prospective Studies ; Retrospective Studies ; Stroke* ; Thrombolytic Therapy ; Tissue Plasminogen Activator ; Urokinase-Type Plasminogen Activator ; Weights and Measures

Acute embolic occlusion of the common iliac artery is a rare medical emergency that is not only limbthreatening, but also potentially life-threatening. Several treatment options exist for acute limb ischemia, although no treatment is clearly best. We report a case of acute embolic occlusion of the left common iliac artery in a patient with atrial fibrillation who was treated successfully using mechanical thrombectomy following intra-arterial thrombolysis.
Acute Disease ; Arterial Occlusive Diseases/radiography/*therapy ; Combined Modality Therapy ; Embolism/radiography/*therapy ; Female ; Fibrinolytic Agents/*administration & dosage ; Humans ; *Iliac Artery/radiography ; Middle Aged ; *Thrombectomy ; *Thrombolytic Therapy ; Tomography, X-Ray Computed ; Treatment Outcome ; Urokinase-Type Plasminogen Activator/*administration & dosage

AIMTo prepare thrombus-targeted urokinase liposomes and observe its improved thrombolytic efficacy on thrombus model rats.

METHODSThe ligand H-Arg-Gly-Asp-Ser-OH (RGDS) which has specific affinity to thrombus was synthesized by liquid phase method and anchored on the surface of liposomes by incorporating its conjugate with DSPE-PEG3,500-COOH into liposomal lipid bilayers, thus thrombus-targeted liposomes were produced. Urokinase (UK) liposomes were prepared at room temperature through method modification using hydrogenated soy phosphatidylcholine (HSPC); the in vivo thrombolysis of the obtained thrombus-targeted UK liposomes and its comparison with TBS (Tris-HCl buffered solution) control, free UK and UK liposomes were assessed on common carotid artery model rats.

RESULTSThe obtained liposomes were characteristic of high UK entrapment efficiency, small mean diameter and good storage stability. At the same dose (60,000 U.kg-1), compared to the wet thrombi weights of TBS control group, those of free UK group and UK liposome group showed no statistical difference, while those of targeted UK liposomes group were significantly decreased (P < 0.001); when evaluated in term of dry thrombi weights the result was slightly different. Compared to UK liposomes of the same dose, the targeted UK liposomes showed significantly improved thrombolytic efficacy (P < 0.01 in wet weights decrease and P < 0.05 in dry weights decrease respectively).

CONCLUSIONThe targeted UK liposomes displayed good targeted thrombolytic effect.

Animals ; Disease Models, Animal ; Drug Carriers ; Drug Delivery Systems ; Fibrinolytic Agents ; administration & dosage ; therapeutic use ; Liposomes ; Male ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Technology, Pharmaceutical ; Thrombosis ; drug therapy ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; administration & dosage ; therapeutic use

BACKGROUNDCatheter-directed thrombolysis (CDT) has been a mainstay in treating deep venous thrombosis (DVT). However, the optimal dosage of a thrombolytic agent is still controversial. The goal of this study was to evaluate the safety and efficacy of low dosage urokinase with CDT for DVT.

METHODSA retrospective analysis was performed using data from a total of 427 patients with DVT treated with CDT in our single center between July 2009 and December 2012. Early efficacy of thrombolysis was assessed with a thrombus score based on daily venography. The therapeutic safety was evaluated by adverse events. A venography or duplex ultrasound was performed to assess the outcome at 6 months, 1 year and 2 years postoperatively.

RESULTSThe mean total dose of 3.34 (standard deviation [SD] 1.38) million units of urokinase was administered during a mean of 5.18 (SD 2.28) days. Prior to discharge, Grade III (complete lysis) was achieved in 154 (36%) patients; Grade II (50-99% lysis) in 222 (52%); and Grade I (50% lysis) in 51 (12%). The major complications included one intracranial hemorrhage, one hematochezia, five gross hematuria, and one pulmonary embolism. Moreover, no death occurred in the study.

CONCLUSIONSTreatment of low-dose catheter-directed thrombosis is an efficacious and safe therapeutic approach in patients with DVT offering good long-term outcomes and minimal complications.

Adolescent ; Adult ; Aged ; Drug Administration Schedule ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Urokinase-Type Plasminogen Activator ; administration & dosage ; adverse effects ; therapeutic use ; Venous Thrombosis ; drug therapy ; Young Adult

OBJECTIVETo investigate the clinical value of local regional administration of urokinase and argatroban through small saphenous vein (SSV) catheter in the treatment of acute deep venous thrombosis in the lower limb (LDVT).

METHODSFifty-six patients with acute LDVT were prospectively randomized into the study group (21 cases, 24 limbs) and control group (35 cases, 36 limbs) for treatment with urokinase and argatroban regionally administered via the SSV catheter and with the same agents given via the peripheral vein, respectively. The patients were examined for changes in serum fibrinogen (FBG) and D-dimer and the perimeter of the affected limbs, and the complications in relation to the agents were observed.

RESULTSBy corrected Chi-square test, the incidence of complications was significantly lower in the study group than in the control group (1/21 vs 4/36, χ(2)=1.92, P≤0.05). Wilcoxon's sign rank test suggested no statistically significant difference between the two groups in the total effective rate (95.8% vs 94.4%, V=0.52, P>0.05), but the total excellent rate differed significantly between them (83.3% vs 55.6%, V=2.36, P≤0.05). Serum FBG underwent no significant variations in the study group during thrombolysis (P>0.05), but decreased significantly in the control group (P≤0.05). The decreases in serum D-dimer and perimeter of the affected limbs occurred earlier in the study group than in the control group (P≤0.05).

CONCLUSIONRegional administration of urokinase and argatroban via small saphenous vein catheter can promote the thrombolytic effect and reduce the risk of hemorrhage in the treatment of LDVT.

Adult ; Female ; Fibrinolytic Agents ; Humans ; Injections, Intravenous ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Pipecolic Acids ; administration & dosage ; therapeutic use ; Saphenous Vein ; Urokinase-Type Plasminogen Activator ; administration & dosage ; therapeutic use ; Venous Thrombosis ; drug therapy ; Young Adult

OBJECTIVETo investigate whether intrapericardial urokinase irrigation along with pericardiocentesis could prevent pericardial constriction in patients with infectious exudative pericarditis.

METHODSA total of 94 patients diagnosed as infectious exudative pericarditis (34 patients with purulent pericarditis and 60 with tuberculous pericarditis, the disease courses of all patients were less than 1 month), 44 males and 50 females, aged from 9 to 66 years (mean 45.4 +/- 14.7 years), were consecutively recruited from 1993 to 2002. All individuals were randomly given either intrapericardial urokinase along with conventional treatment in study group, or conventional treatment alone (including pericardiocentesis and drainage) in control group. The dosage of urokinase ranged from 200000 to 600000 U (mean 320000 +/- 70000 U). The immediate effects were detected by pericardiography with sterilized air and diatrizoate meglumine as contrast media. The long-term investigation depended on the telephonic survey and echocardiographic examination. The duration of following-up ranged from 8 to 120 months (mean 56.8 +/- 29.0 months).

RESULTSPercutaneous intrapericardial urokinase irrigation promoted complete drainage of pericardial effusion, significantly reduced the thickness of pericardium (from 3.1 +/- 1.6 mm to 1.6 +/- 1.0 mm in study group, P < 0.001; from 3.4 +/- 1.6 mm to 3.2 +/- 1.8 mm in control group, P > 0.05, respectively), and alleviated the adhesion. Intrapericardial bleeding related to fibrinolysis was found in 6 of 47 patients with non-blood pericardial effusion and no systemic bleeding and severe puncture-related complication was observed. In follow-up, there was no cardiac death, and pericardial constriction events were observed in 9 (19.1%) of study group and 27 (57.4%) of control group. Cox analysis illustrated that urokinase could significantly reduce the occurrence of pericardial constriction (relative hazard coefficient = 0.185, P < 0.0001).

CONCLUSIONThe early employment of intrapericardial fibrinolysis with urokinase and pericardiocentesis appears to be safe and effective in preventing the development of pericardial constriction in patients with infectious exudative pericarditis.

Adolescent ; Adult ; Aged ; Child ; Female ; Fibrinolytic Agents ; administration & dosage ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pericardiocentesis ; Pericarditis ; drug therapy ; therapy ; Pericarditis, Constrictive ; prevention & control ; Thrombolytic Therapy ; Urokinase-Type Plasminogen Activator ; administration & dosage

OBJECTIVETo develop thrombus-targeted urokinase immune liposome through incorporating D-dimer monoclonal antibody (DDmAb) to liposome and observe the thrombolytic efficiency in a rabbit pulmonary thromboembolism (PE) model.

METHODSReverse-phase evaporation method was used to develop targeted urokinase immune liposome by coupling DDmAb to urokinase liposome (liposomal-encapsulated urokinase) with glutaraldehyde. The PE models were induced by injecting 4 autologous emboli (2 mm x 5 mm) through jugular vein catheter into pulmonary arteries. New Zealand white rabbits (n = 32) were randomized into four groups: A group (TBS), B group (150 000 IU/kg UK), C group (30 000 IU/kg urokinase liposome) and D group (30 000 IU/kg urokinase immune liposome). The right ventricular pressure and the emboli size in pulmonary arteries were determined.

RESULTSThe right ventricular pressure increased significantly in PE rabbits (P < 0.01), the average value is (6.75 +/- 6.82) mm Hg (1 mm Hg = 0.133 kPa). Eighty minutes post various treatments, right ventricular pressure remained unchanged as post PE in group A [(40.15 +/- 11.22) mm Hg vs. (41.67 +/- 14.23) mm Hg], decreased to baseline level in group B and D [(34.71 +/- 8.67) mm Hg vs. (33.98 +/- 9.32) mm Hg, (30.65 +/- 6.67) mm Hg vs. (30.77 +/- 6.85) mm Hg, all P > 0.05], decreased but not returned to normal value in group C. Residual emboli size remained unchanged in group A and partly reduced in group C and more significantly reduced in group B and D. Hemorrhage of heart, kidney and liver was evidenced in group A but not in other groups.

CONCLUSIONAcute PE could be successfully treated by the thrombus-targeted urokinase immune liposome with D-dimer monoclonal antibody.

Animals ; Antibodies, Monoclonal ; administration & dosage ; Blood Pressure ; Disease Models, Animal ; Fibrin Fibrinogen Degradation Products ; immunology ; Fibrinolytic Agents ; therapeutic use ; Liposomes ; Pulmonary Embolism ; drug therapy ; physiopathology ; Rabbits ; Thrombolytic Therapy ; methods ; Urokinase-Type Plasminogen Activator ; administration & dosage

OBJECTIVETo observe the safety and efficacy of local intra-arterial thrombolysis (LIT) in patients with acute ischemic stroke of cervical internal carotid artery occlusive disease.

METHODS10 patients were treated by LIT. 2 of 10 patients were further treated by either angioplasty or endarterectomy. Primary neuroradiological assessment was performed with CT in all patients. Angiographic recanalization level was classified according to thrombolysis in myocardial infarction (TIMI) grades. Clinical outcome was classified as good for Modified Rankin Scale (MRS) scores of 0 to 3 and as poor for MRS scores of 4 to 6.

RESULTSComplete/partial recanalization after infusion was accomplished in 8 patients, seven of whom had good clinical outcome. Cerebral hemorrhage occurred in 2 of 10 patients.

CONCLUSIONThe results of this study suggest that LIT may be helpful to improve the outcome in patients with acute cervical internal carotid artery occlusive disease if it is performed within 6 hours of stroke onset.

Adolescent ; Adult ; Aged ; Carotid Artery, Internal ; Carotid Stenosis ; complications ; drug therapy ; Female ; Humans ; Infusions, Intra-Arterial ; Male ; Middle Aged ; Stroke ; drug therapy ; etiology ; Thrombolytic Therapy ; methods ; Urokinase-Type Plasminogen Activator ; administration & dosage