Heterogeneity in Standard Operating Procedures for Catheter Directed Thrombolysis for Peripheral Arterial Occlusions in The Netherlands: A Nationwide Overview

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
Bernard S LeenstraGert Jan de Borst

Abstract

Catheter directed thrombolysis (CDT) for acute arterial occlusions of the lower extremities is associated with a risk of major bleeding complications. Strict monitoring of vital functions is advised for timely adjustment or discontinuation of thrombolytic treatment. Nevertheless, current evidence on the optimal application of CDT and use of monitoring during CDT is limited. In this study the different standard operating procedures (SOPs) for CDT in Dutch hospitals were compared against a national guideline in a nationwide analysis. SOPs, landmark studies, and national and international guidelines for CDT for acute lower extremity arterial occlusions were compared. The protocols of 34 Dutch medical centres where CDT is performed were assessed. Parameters included contraindications to CDT, co-administration of heparin, thrombolytic agent administration, angiographic control, and patient monitoring. Thirty-four SOPs were included, covering 94% of medical centres performing CDT in the Netherlands. None of the SOPs had identical contraindications and a strong divergence in relative and absolute grading was found. Heparin and urokinase dosages differed by a factor of five. In 18% of the SOPs heparin co-administration was not mentione...Continue Reading

References

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Nov 3, 2009·Journal of Thrombosis and Haemostasis : JTH·S SchulmanUNKNOWN Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on T
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May 13, 2017·Vascular Medicine·UNKNOWN Writing Committee MembersDuminda N Wijeysundera
Aug 31, 2017·European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery·Victor AboyansJose Luis Zamorano
Dec 10, 2017·Annals of Vascular Surgery·Harm P EbbenKakkhee Yeung

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