Intra-arterial thrombolysis: Is ICU admission necessary?

Background: Intra-arterial thrombolysis is an effective and safe method for treating acute limb ischaemia. However, during thrombolysis, patients are at risk of life-threatening haemorrhagic complications. In the literature there is no consensus on how patients should be monitored during treatment. Patients in our hospital are admitted to an intensive care unit (ICU) during treatment even though ICU beds are scarce and ICU admission is a stressful event. This raises the question: is ICU admission necessary to prevent major bleeding complications? Methods: A retrospective study was conducted where all patients having received intra-arterial thrombolysis between January 2015 and February 2017 were included. Patients' files were reviewed for adverse events, laboratory results, information about transfusion of blood products and additional interventions. Results: In total 52 procedures were analysed. No major complications and no haemodynamic instability occurred; 11 minor complications occurred in nine individual patients (18.8%). No transfusions of fresh frozen plasma or packed red blood cells were given during thrombolysis. In three patients packed red blood cells were given within one week of thrombolysis. No other additional treatment was necessary. Conclusions: Treatment outside of the ICU during peripheral intra-arterial thrombolysis should be considered a safe option on the condition that continuous patient monitoring for local and systemic complications is carried out. A protocol for escalation of treatment in case a complication occurs is mandatory.