Objective: To evaluate the efficacy and safety of thrombolytic therapy with urokinase after systemic-pulmonary shunt.
Methods: Six patients who had thrombosis after systemic-pulmonary shunt were enrolled in this study. At the background of administration of the heparin at a dose of 0.2-0.3 U x kg(-1) min(-1), urokinase was intravenously administered with a loading dose of 15-20 U x kg(-1) x min(-1) and a locked time period of 30 minutes, and then the dose was incessantly decreased to 4-10 U x kg(-1) x min(-1). In addition to echocardiography (ECG), arterial partial pressure of oxygen/inspired oxygen fraction (PaO2/FiO2), fibrinogen, activated partial thromboplastin time, and prothrombin time were determined to assess the clinical efficacy and side effects.
Results: The thrombolytic therapy with urokinase showed clinical effectiveness within 1 or 2 hours in all 6 patients. Efficiency of this therapy reached 100% during 12 to 24 hours. In 5 patients, the PaO2/FiO2 were over 50% higher than the early postoperative values. One patient received a second operation due to the excessively increased pulmonary blood flow. In 2 patients, pleural and mediastinal drainages increased when the thrombolytic therapy with urokinase began; however, they decreased after the urokinase dosages were adjusted.
Conclusion: It is feasible to use the thrombolytic therapy with proper dosage of urokinase after systemic-pulmonary shunt.