Longitudinal quality of life assessment of patients with hepatocellular carcinoma after primary transarterial chemoembolization.

PURPOSE: To determine the effects of primary chemoembolization on the health-related quality of life (HRQOL) of patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Single-center prospective data collection with longitudinal analysis of HRQOL scores obtained via the Short Form-36 (SF-36) assessment tool was performed before and during serial chemoembolization procedures in 73 patients with HCC. Baseline HRQOL scores were evaluated for significant (P < .05) change within the total patient population during 4, 8, and 12 months of treatment, and separately within a subset of 23 patients who underwent three or more chemoembolization procedures. RESULTS: Patients had decreased pretreatment baseline scores within all eight scales of the SF-36 compared with healthy age-adjusted norms. Within the total population, mental health scores improved after 4 months of chemoembolization (rate of change, 5.6; P = .05; n = 48), but no significant change was present at 8 or 12 months. Subset patients experienced improvements of mental health scores after the first (score change, 13; P = .008; n = 21) and second procedures (score change, 12.2; P = .002; n = 23) and improvements of bodily pain scores (score change, 9.9; P = .047; n = 21) after the initial procedure. Vitality scores worsened (score change, -7.8; P = .044; n = 21) in the subset after the first chemoembolization. CONCLUSIONS: Patients with HCC are likely to perceive improved mental health during the first 4 months of primary treatment with chemoembolization. In addition, if patients ultimately undergo more than two procedures, they are likely to perceive improved mental health during the first two sessions, with decreased bodily pain during the initial session. Patient-perceived vitality will likely worsen after the initial procedure.

Initial experience with the combination of reteplase and abciximab for thrombolytic therapy in peripheral arterial occlusive disease: a pilot study.

PURPOSE: To report the efficacy of catheter-directed thrombolysis with a combination of a thrombolytic agent (reteplase) and a glycoprotein (GP) IIb/IIIa platelet receptor antagonist (abciximab) in peripheral arterial occlusive disease. MATERIALS AND METHODS: Fifteen patients with lower extremity arterial thromboses (age range, 40-96 y; mean, 73 y) were prospectively enrolled in a protocol approved by the Institutional Review Committee. Nine patients had native arterial occlusions, three (33%) of whom had subacute symptoms (>14 d) and one of whom had chronic symptoms (>3 mo). Four patients had acute arterial graft thromboses. Two patients with lower extremity bypass grafts presented with subacute limb ischemia. All patients received catheter-directed infusion of reteplase (0.5 U/h) in combination with intravenous administration of abciximab (0.25-mg/kg bolus followed by 0.125 microg/kg/min infusion) for 12 hours without systemic heparinization. The thrombolytic success was studied by Doppler ultrasonography (US) and angiography. RESULTS: Complete thrombolysis and clinical success was achieved in 14 of the 15 patients (93%). One patient with unsuccessful thrombolysis underwent major amputation. The mean thrombolysis time per Doppler US procedure was 6.8 hours (range, 2-30 h). Angiographic patency was achieved at a mean of 17.5 hours (range, 4-36 h) corresponding to a mean dose of reteplase of 8.8 U. The mean increase in ankle-brachial index was 0.52 (range, 0-0.9). No major hemorrhagic complications occurred. The 30-day primary patency rate was 93%. CONCLUSION: The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. This combination therapy pilot study suggests short thrombolysis times and minimal adverse effects in catheter-directed thrombolytic therapy for peripheral arterial occlusive disease.

Catheter-directed thrombolytic therapy in peripheral artery occlusions: combining reteplase and abciximab.

OBJECTIVE: The goal of this study was to assess the safety and efficacy of combination therapy consisting of the third-generation plasminogen activator reteplase and the glycoproteins IIb and IIIa platelet receptor antagonist abciximab for thrombolysis in peripheral artery occlusive disease. This two-center experience focused on immediate thrombolytic success, thrombolysis time, complication rate, and 30-day patency rate. SUBJECTS AND METHODS: Fifty patients with arterial occlusive disease (age range, 40-96 years; mean age, 69 years) were prospectively enrolled at two centers. Eighteen patients (36%) had native artery thromboses, and 32 patients (64%) had graft thromboses. Catheter-directed intraarterial thrombolytic infusion of reteplase (average dose, 0.51 U/hr; range, 0.25-1 U/hr) was combined with IV infusion of abciximab (bolus, 0.25 mg/kg of body weight; 12-hr infusion, 0.125 microg/kg of body weight per minute). Nontherapeutic heparin (100-400 U/hr) was given intraarterially during the thrombolytic infusion. RESULTS: Complete thrombolysis was achieved in 89% of the patients with native artery occlusions and 94% of the patients with graft occlusions for an overall rate of 92%. The average thrombolysis time was 20.7 hr (range, 4-41 hr) with a mean reteplase dose of 12.1 U (range, 2-23 U). Major hematoma occurred in 12% of the patients, with an average blood transfusion of 3.1 U of packed RBC (range, 1-11 U), and correlated to increased thrombolysis time and dose. No intracranial hemorrhage occurred. The 30-day primary patency rate was 92%. Two patients (4%) underwent amputation, including one major amputation (2%), within 30 days of thrombolysis. CONCLUSION: The combination of reteplase and abciximab in catheter-directed arterial thrombolysis is feasible and effective. Results of this combination therapy suggest acceptable thrombolysis times and doses with tolerable complication rates. Which patient group might benefit the most from combination therapy and the long-term results of combination therapy still need to be determined.