Level 2: Mid-level evidence
A Cochrane review of five randomized trials compared thrombolysis vs. surgery as initial treatment in 1,283 patients with acute limb ischemia (Cochrane Database Syst Rev. 2009;[2]:CD002784). There were no significant differences in limb salvage or mortality at 30 days, six months, or one year. However, thrombolysis was associated with higher 30-day rates of stroke (1.3% vs. 0, P =.0097, NNH 76), major hemorrhage (8.8% vs. 3.3%, P =.000049, NNH 18), and distal embolization (12.4% vs. 0, P <.00001, NNH 8). Meta-analyses were limited by clinical heterogeneity, differences in reporting methods, and variations in thrombolytic techniques.