A Cochrane review included 5 studies with a total of 687 subjects with a wide range of clinical presentations from intermittent claudication to critical limb ischaemia. In one three-pronged study, vessel patency was greater with intra-arterial recombinant tissue plasminogen activator (rt-PA) than with intra-arterial streptokinase (P < 0.04) or intravenous rt-PA (P < 0.01). In patients with peripheral arterial occlusion there was no statistically significant difference in limb salvage at 30 days with either urokinase or rt-PA, though this may reflect the small numbers in the studies. Incidences of haemorrhagic complications varied with fibrinolytic regime but there was no statistically significant difference between intra-arterial urokinase and intra-arterial rt-PA. In the three-pronged study intravenous rt-PA and intra-arterial streptokinase were associated with a significantly higher risk of haemorrhagic complications than intra-arterial rt-PA (P < 0.05).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), by inconsistency (heterogeneity in patients, interventions and outcomes), and by imprecise results (limited study size for each comparison).