STUDY OBJECTIVE: To evaluate differences in the efficacy and safety of recombinant tissue plasminogen activator (rt-PA) and urokinase in the treatment of peripheral @entity432 . DESIGN: Systematic review and meta-analysis of prospective comparative trials. DATA SOURCE: PubMed/MEDLINE database from 1966-October 2004. MEASUREMENTS AND MAIN RESULTS: The literature was systematically searched to identify prospective comparative trials of urokinase and rt-PA for the treatment of peripheral @entity432 . The primary outcome measure was successful complete lysis of the occlusion. Other outcome measures were @entity548 (major, minor, or combined), @entity932 , limb loss, and mortality. Six trials were identified, five of which were randomized. On meta-analysis, the rate of clot lysis was higher with rt-PA than with urokinase (odds ratio [OR] 1.54, 95% confidence interval [CI] 1.12-2.10, p=0.007). However, urokinase was associated with lower rates of minor (OR 0.52, 95% CI 0.28-0.97, p=0.04) and total (OR 0.51, 95% CI 0.29-0.91, p=0.02) @entity548 . Rates of major @entity548 , @entity932 , limb loss, and mortality were similar between agents. CONCLUSION: Urokinase was less effective than rt-PA in successfully lysing acute peripheral @entity432 , but it was associated with lower rates of total and minor @entity548 . Overall, rt-PA was a reasonable substitute for urokinase, now that urokinase has been removed from the market in the United States. However, judicious monitoring for minor @entity548 is necessary.

Comparative safety and efficacy of urokinase and recombinant tissue plasminogen activator for peripheral XXXX : a meta-analysis.

@entity432 :: ('MESH:D001157', 'Disease') :: ['arterial occlusion'] @entity932 :: ('MESH:D020300', 'Disease') :: ['intracranial hemorrhage'] @entity548 :: ('MESH:D006470', 'Disease') :: ['bleeding', 'hemorrhage']
@entity432 :: (MESH:D001157,Disease) :: ['arterial occlusion']
