Book Review

Thrombolytic Therapy for Peripheral Vascular Disease

N Engl J Med 1995; 333:395-396August 10, 1995

Article

Thrombolytic Therapy for Peripheral Vascular Disease
Edited by Anthony J. Comerota. 553 pp., illustrated. Philadelphia, J.B. Lippincott, 1995. $89.50. ISBN: 0-397-51343-7

It is rare that a medical textbook combines a well-written, comprehensive review of basic science with a thorough clinical review. Such is the case with Thrombolytic Therapy for Peripheral Vascular Disease, a superb book edited by Anthony J. Comerota. The title is misleading, since the book deals with thrombolytic therapy for pulmonary embolus, myocardial infarction, and stroke as well as all types of peripheral venous and arterial thrombosis. The book's 30 chapters, by 47 contributors, range from comprehensive reviews of the properties of the fibrinolytic proteins to specific recommendations for managing particular clinical problems. There are even chapters on mechanical devices for the instillation of thrombolytic agents and on the fibrinolytic agents of the future. A chapter on the history of fibrinolytic therapy by the late Sol Sherry is an excellent narrative of the early days of this field.

I used this book as a reference for clinical problems during the period of my review of it. I found it an excellent manual for the practitioner. It advised me on options for specific problems and gave specific recommendations on how to proceed. The references are up to date and comprehensive.

No textbook is perfect, and of course, portions of this one could be improved. Many of the topics it covers suffer from a lack of prospective data that define optimal therapy. Therefore, the authors have based some recommendations on anecdotal literature or their own experience. At times different approaches to specific problems are neglected, leaving the reader with only the author's approach. This clinical textbook could have given more attention to the pros and cons of various approaches. For example, the authors give no rationale for their frequent recommendation that urokinase be used in preference to other agents. These issues are important for clinical decision making. Lastly, a book that emphasizes thrombolytic approaches to thrombotic problems should thoroughly review alternative treatments so that the reader can decide which approach is most appropriate for a particular problem.

Despite these criticisms, this is an excellent review of a complex subject. The discussion of basic science is comprehensive; the clinical topics are relevant to the subspecialist and the general practitioner. I look forward to future editions of this textbook as the rapidly growing field of thrombolysis evolves.

Steven Limentani, M.D.
New England Medical Center, Boston, MA 02111