Thrombolysis is an essential first step in the surgical management of acute spontaneous axillo-subclavian vein
thrombosis (
Paget-Schroetter syndrome). During the past decade,
Urokinase became the standard
thrombolytic agent until temporarily withdrawn from the market. In its absence, recombinant
tissue plasminogen activator (r-TPA) was introduced and attained widespread use. A direct comparison of the efficacy of these two agents in this setting has not been published. The goal of this study is to compare
thrombolytic agents in the management of acute
Paget-Schroetter syndrome. This study is based on a retrospective review of 30 consecutive patients (15
Urokinase, 15 r-TPA) who underwent thrombolysis and surgery for
Paget-Schroetter syndrome. Our hypothesis is that thromblysis with
Urokinase and r-TPA is equally safe and effective in management of acute axillo-subclavian vein
thrombosis. Primary outcome measures include success of lysis, hemorrhagic complications, subclavian vein patency at completion of treatment, resolution of presenting symptoms, and restitution of normal arm function. There were no significant differences in the primary outcome measures: success of lysis, hemorrhagic complication, perioperative
bleeding, and subclavian vein patency. Time to completion of lysis was slightly shorter with r-TPA (but this did not achieve statistical significance). One patient in each group suffered incomplete lysis of
thrombus. One patient in the r-TPA group required transfusion due to surgical
bleeding. No patient received transfusion due to thrombolysis-related
bleeding. All patients experienced resolution of symptoms and return of arm function. Our findings support the hypothesis that
Urokinase and r-TPA are similarly safe and successful for management of spontaneous axillo-subclavian vein
thrombosis. Given these results, secondary factors such as cost, availability, and familiarity with the different agents will likely determine the agent of choice.