Avoiding the complications of thrombolysis

Background: NATALI is a voluntary database of patients undergoing peripheral vascular thrombolysis run on behalf of the Thrombolysis Study Group. The size of the data set allows analysis to identify predictors of outcome and complications. These may be patient factors or variables related to the technique used. Methods: Since its inception on 1 January 1990, 798 thrombolytic events have been recorded. Details are collected on a wide range of factors: perceived risk factors; details of thrombolysis technique; complications; outcome; and adjunctive procedures. Using univariate and multivariate analysis, factors associated with an increased risk of complications were investigated. Results: Death and complications (perilysis) occurred in 25·9 per cent of episodes ( n = 207). Patient factors were the main influence on the risk of complications. Increasing age, use of aspirin and thrombolysis of grafts were significantly associated with an increased risk of complications after adjustment for confounders ( P < 0·05). Female sex, the presence of peripheral vascular disease and Fontaine class were of borderline significance. Other patient factors were not associated with an increased risk of complication. Aspects of radiological technique, such as agent used, sheath size, length of lysis, dose of lysis, use of heparin or adjunctive procedures, had no relationship to the rate of complications. Conclusion: Case selection is the most important factor influencing the occurrence of complications. Radiological technique does not seem to influence the occurrence of complications. © 1999 British Journal of Surgery Society Ltd