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[Experiences with loco-regional fibrinolytic therapy of deep venous thrombosis with defined drainage management].

From 1989 to September 1997 1184 patients with deep vein thrombosis were treated. 606 (51.2%) received a specific therapy with loco-regional lysis. The application of two cycles of 20 mg Alteplase within 8 hours prevailed in combination with 1000 IE heparin per hour. In absence or lack of therapeutical effect further cycles of 20 or 40 mg of Alteplase were given. In the time free from lysis the patients received 30,000 IE heparin/24 hours depending on the individual aPTT (1.5-2.5 times prolonged). We developed a special drainage-management using perforans-veins during the loco-regional lysis. Complete lysis resulted in nearly half of the cases and in another third there was a lysis of more than 50%. Complications were observed in 5.8% of the patients, 4% due to heparinization. Importantly no life-threatening bleeding like gastrointestinal or cerebral bleeding or pulmonary embolism occurred. According to our data we conclude that the loco-regional lytic effect tends to be better than using systemical lysis, the risks are minimized and patient monitoring and treatment is much simpler.