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Objective: Catheter-directed thrombolysis is a well-established treatment strategy for patients with acute limb ischemia. Treatment guidelines, however, have not been established regarding age limit and use of catheter-directed thrombolysis. We performed a survey of vascular specialist to ascertain best practice guidelines with regard to age limits.
Methods: 113 vascular practioners were sent a survey powered by survey monkey to help establish normal practice guidelines for the use of catheter-directed thrombolysis with use of tissue plasminogen activator (tpa).
Results: Eleven questions were generated on survey monkey and distributed to vascular specialists. Questions ranged from dosage of tpa infusion, duration of tpa infusion, laboratory values monitored, age limitation for performing overnight catheter-directed thrombolysis to complications. 67.3% of responder’s state they perform between and 5 and 20 catheter-directed cases per year. 84.1% of practioner’s combined tpa infusion with heparin. Of the 113 responders asked about duration of tpa infusion, 70.8% state they perform 24-48 hour tpa infusion. 32.7% of responder’s state they do not have an age limitation for tpa infusion, of the remaining responders 29.2% use 80 years of age as their limitation for tpa infusion. When asked why place limits on age for tpa infusion, 56.6% state concern for intracranial hemorrhage as reason to not perform overnight tpa infusion. Major complications noted by responders were access site hemorrhage (58.4%) and intracranial hemorrhage (41.6%). When asked about age group in which complications occurred most commonly, 72.4% were less than 80.
Conclusions: Amongst vascular specialist there seems to be no consensus on age limitations for tpa infusion. Serious complications, among responders, does not seem to be related to age. Therefore, we believe age alone should not be used as a contraindication to tpa infusion.