Thrombolysis involves dissolving a blood clot by injecting an enzyme into the blood clot. It is used as an alternative to surgery for managing severely reduced blood flow (acute ischaemia) in the leg. A blood clot (thrombosis) forms in a leg blood vessel where there is severe narrowing (stenosis) in a natural artery or a bypass graft.
The review authors identified five controlled trials with a total of 1283 participants who were randomly allocated to receive initial peripheral arterial thrombolysis or surgery for the immediate management of acute limb ischaemia. There was no evidence in favour of either initial thrombolysis or initial surgery as the preferred option in terms of preventing the need for major amputation (limb salvage) or death within one year. More major complications occurred within 30 days of the procedure with thrombolysis, including stroke and major bleeding (haemorrhage). A total of 1.3% of patients receiving thrombolysis had a stroke compared to none in surgery patients; 8.8% had a major haemorrhage after thrombolysis compared to 3.3% in surgery patients. People receiving initial thrombolysis underwent a less severe degree of intervention but may have a higher risk of ongoing limb ischaemia. These
higher risks of complications with thrombolysis have to be weighted against individual risks in surgery. Either recombinant tissue plasminogen activator or urokinase were the agents used for thrombolysis.