Recommended Time Duration for Urokinase Injection in Normal Solution
For intra-arterial thrombolysis, urokinase should be infused at a rate of 5,000 to 20,000 IU/minute for a duration of 1-2 hours, with total doses typically ranging from 200,000 to 1,300,000 IU depending on the clinical scenario. 1
Dosing and Duration by Clinical Application
Intra-arterial Thrombolysis for Neuroendovascular Procedures
- Initial dose: 500,000 IU administered initially
- Infusion rate: 5,000-20,000 IU/minute
- Duration: Typically 1-2 hours
- Total dose range: 200,000-1,300,000 IU (reported mean dose of 975,000 IU in one series)
- Follow-up: If no recanalization is achieved, mechanical disruption may be performed followed by additional urokinase 1
Pulmonary Embolism Treatment
- Loading dose: 4,000 U/kg body weight given as a bolus
- Maintenance: 4,000 U/kg/hour
- Duration: 12 to 24 hours
- Administration: Via unilateral or bilateral pulmonary artery infusions 2
Pleural Infection in Children
- For children ≥1 year: 40,000 units in 40 ml 0.9% saline
- For children <1 year: 10,000 units in 10 ml 0.9% saline
- Frequency: Twice daily
- Duration: 3 days (6 doses total)
- Dwell time: 4 hours 1
Hemodialysis Catheter Thrombolysis
- Standard protocol: 5,000 U/ml to the volume of the catheter lumen with 1-hour dwell time
- Low-dose protocol: 2,500 U/lumen followed by saline to fill the lumen with 1-hour dwell time
- Add mid-dwell injection of 0.2 ml/lumen saline to advance the active urokinase front
- The low-dose protocol is equally effective while reducing urokinase usage by 81% 3
Factors Affecting Duration and Dosing
Clinical indication: Different applications require different durations (from 1 hour for catheter thrombolysis to 24 hours for pulmonary embolism)
Location and size of thrombus: Larger thrombi may require longer infusion times and higher total doses
Patient response: Monitor for recanalization and adjust duration accordingly
Bleeding risk: Patients with higher bleeding risk may require shorter durations or lower doses
Monitoring During Administration
- Frequent control injections of contrast material during neuroendovascular procedures
- Neurological examinations in non-anesthetized patients
- Monitor for bleeding complications, especially at puncture sites
- For catheter thrombolysis, check blood flow rates (success defined as >200 ml/min) 3
Potential Complications and Precautions
- Bleeding: Most common complication, especially at puncture sites
- Rebleeding: Reported in 35% of patients receiving urokinase for intracerebral hemorrhage 1
- Allergic reactions: Rare immediate hypersensitivity reactions have been reported 1
- Discomfort: May occur during intrapleural injection; can be managed with intrapleural bupivacaine 1
Special Considerations
- For patients with contraindications to systemic thrombolytic therapy, localized administration (such as intrapulmonary artery infusion) may still be safe and effective 2
- In children with pleural infection, if response is incomplete after six doses, additional urokinase doses can be given 1
- For hemodialysis catheters, advancing the active front of urokinase with saline mid-dwell improves efficacy even with lower doses 3
Remember that the specific duration and dosing of urokinase should be tailored based on the clinical indication, location of administration, and patient-specific factors such as bleeding risk and response to therapy.