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Recombinant tissue plasminogen activator (rtPA) offers the potential advantages of convenience of administration (need not be given by infusion) and high efficacy in the treatment of acute, pulmonary embolism. To evaluate the efficacy of rtPA, a new thrombolytic agent, in the treatment of deep vein thrombosis (DVT). Sixteen patients with objectively proved DVT received rtPA. Ten patients with anterior myocardial infarction (AMI) or unstable angina pectoris (UAP) were scheduled for coronary angiography and restenosis after thrombolysis. Although diagnosis of DVT was confirmed in all cases by phlebography, duplex scanning, and standard phlebography, the mean (+/- SEM) time interval between onset of symptoms and phlebography was 4.4 +/- 0.6 days. The mean (+/- SEM) dose of rtPA was 0.09 +/- 0.01 mg/kg of body weight. The overall incidence of major bleeding complications was 63%, and was higher in patients receiving concurrent aspirin therapy than in patients without aspirin. At a mean (+/- SEM) follow-up of 17.5 +/- 5.3 days, there were three major complications (19%) and four minor complications (25%). There was one reocclusion of the veins before hospital discharge and one pulmonary embolism in the early posttreatment period. Six patients with inferior vena cava (IVC) thrombosis were successfully treated (Vena-Auricular Syndrome); all patients resumed normal living activities within five days. Neither reocclusion nor embolic events occurred in patients with AMI or UAP. Treatment of DVT with rtPA has a high rate of major bleeding complications, especially in patients receiving aspirin. Aspirin may reduce the incidence of thrombosis recurrence. In patients with AMI or UAP, it appears to confer no specific advantage over other antithrombotic agents. rtPA is safe and effective for DVT in a dose of 0
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