Alteplase versus urokinase in restoring blood flow in hemodialysis-catheter thrombosis

Eyrich, Heather M; Walton, Ted; Macon, Edwin J.; Howe, Andrew

doi:10.1093/ajhp/59.15.1437

Cited by 34 publications

(32 citation statements)

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“…Thrombolysis is a well-established method of restoring patency in a situation of malfunction due to fibrin sheath formation or partial catheter thrombosis. Numerous infusion regimens have been reported using urokinase and alteplase with high rates of success [15,[17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Radiological placement of chest ports in pediatric oncology patients

Çil

2004

Eur Radiol

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A single center's procedural and follow-up results of radiological chest port placement in pediatric oncology patients are presented. Between July 2002 and December 2003, 37 children (20 boys, 17 girls; age range, 4 months to 16 years; mean 6.7 years) underwent chest port placement. All patients received only one port through the internal jugular vein access, and all of the implantations were performed in the interventional radiology suite. Our database and electronic charts were retrospectively reviewed to obtain follow-up data. All chest ports were successfully implanted. The mean catheter life was 223 days (range: 15-450 days), with a total of 8,258 catheter days. Twenty-eight ports are still in use, four patient deceased, one port was prematurely removed because of a late infection, and four patients were lost to follow-up. Infection rate was 2.7% (0.12/1,000 catheter days). Malfunction due to partial catheter thrombosis and fibrin sheath formation was observed in three patients (8.1% or 0.36/1,000 catheter days), and all were relieved with rt-TPA dwell. None of the ports were revised or removed because of blockage, malposition or difficulty accessing the port. The peri-procedural complication rate was 0%. Chest ports in children can be inserted in interventional radiology suites under imaging guidance with high rates of technical success. The rates of infection and complications are comparable to that of surgically placed ports.

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Section: Discussionmentioning

confidence: 99%

Radiological placement of chest ports in pediatric oncology patients

Çil

2004

Eur Radiol

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“…For example, a continuous infusion of urokinase (250,000 U) over 3 hours during dialysis might prove effective (28). Use of recombinant tissue thromboplastin activator (r‐TPA) might be more efficacious than urokinase (29,30). Fibrin sheath stripping is falling out of favor among interventionalists, since it offers no advantage over catheter exchange and simply adds to the cost of treatment (22).…”

Section: Thrombotic Complicationsmentioning

confidence: 99%

UNRESOLVED ISSUES IN DIALYSIS: Long‐Term Management of the Tunneled Venous Catheter

Liangos

Gul

Madias

et al. 2006

Seminars in Dialysis

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Despite their propensity for significant complications, tunneled central venous catheters have become a common means of vascular access in the United States for patients requiring maintenance hemodialysis for end-stage renal disease (ESRD). Reasons for their use include advanced patient age, peripheral vascular disease (arterial and venous), late referral for creation of vascular access, and more importantly, the lack of an interdisciplinary service line on vascular access among vascular surgeons, radiologists, and nephrologists. This review article summarizes complications commonly encountered in dialysis patients who use tunneled central venous catheters for vascular access-mainly thrombosis, stenosis, and infection. Special attention is given to novel approaches for the prevention of catheter-associated infections. Effective prevention and timely treatment of common catheter-associated complications can reduce the substantial morbidity associated with the use of these devices. However, these measures should not detract from the goal of avoiding or limiting the long-term use of catheters, thereby optimizing vascular access management by ensuring the timely availability of functioning arteriovenous fistulas.

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“…However, the authors did not conduct a comparative analysis of 1.0 mg vs. 2.0 mg and defined normal flow using liberal cut‐off point of 200 mL/minute. Eyrich et al., however, reported a 70% success rate among patients who received 1.0 mg tPA in a retrospective study of 27 patients. These aforementioned rates may suggest additional evidence to the efficacy of administering 2.0‐mg dose over 1.0 mg.…”

Section: Discussionmentioning

confidence: 97%

Comparison of alteplase (tissue plasminogen activator) high‐dose vs. low‐dose protocol in restoring hemodialysis catheter function: The ALTE‐DOSE study

Yaseen

El-Masri

Nekidy

et al. 2012

Hemodialysis International

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Hemodialysis catheter (HDC) dysfunction due to thrombosis is common, and dysfunction incidence can reach up to 50% within 1 year of use. Although administration of intraluminal alteplase (tissue plasminogen activator [tPA]) is the standard of practice to pharmacologically restore HDC function, there are no evidence-based guidelines concerning the optimal tPA dose. The purpose of this study was to compare the efficacy of 1.0-mg vs. 2.0-mg tPA dwell protocols in restoring the HDC function in thrombotic dysfunctional catheters. A retrospective, single-center study was conducted on two independent cohorts of patients; the first (n = 129) received 2.0 mg tPA/catheter lumen, while the second (n=108) received 1.0 mg tPA/catheter lumen. Kaplan-Meier and Cox regression analyses were performed to compare the catheter survival time between patients who received 1.0 mg tPA and those who received 2.0 mg tPA. Catheter removal occurred in 25 (19.4%) of those catheters treated with 1.0 mg tPA compared with 11 (10.2%) of catheters treated with 2.0 mg tPA (P = 0.05). The hazard ratio (HR) for catheter removal was 2.75 (95% confidence interval [(95%) CI] = 1.25-6.04) for the 1.0-mg tPA cohort compared with the 2.0-mg tPA cohort. Correction added on 3 December 2012, after first online publication: The tPA cohort values were changed. Female gender (HR = 2.51; (95%) CI = 1.20-5.27) and age (HR = 0.96; (95%) CI = 0.94-0.98) were also associated with catheter survival. Our findings suggest that treatment of dysfunctional HDC with 2.0-mg tPA dwells is superior to 1.0-mg tPA dwells.

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Alteplase versus urokinase in restoring blood flow in hemodialysis-catheter thrombosis

Cited by 34 publications

References 0 publications

Radiological placement of chest ports in pediatric oncology patients

Radiological placement of chest ports in pediatric oncology patients

UNRESOLVED ISSUES IN DIALYSIS: Long‐Term Management of the Tunneled Venous Catheter

Comparison of alteplase (tissue plasminogen activator) high‐dose vs. low‐dose protocol in restoring hemodialysis catheter function: The ALTE‐DOSE study

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