Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: a randomised controlled trial

Abstract

Alteplase is significantly more effective than heparin in preventing clot formation in central haemodialysis lines. This reduces morbidity and improves preservation of central venous access. It is more expensive, though relatively economic if packaged into syringes and stored frozen until needed, but reduces the costs of unblocking or replacing clotted lines.

Vascular access: choice and complications in European paediatric haemodialysis units

“…A prospective study in children in the UK compared heparin 5000 unit/ml to alteplase 1 mg/ml and showed a significant reduction in CVC clot formation with alteplase as the standard lock solution [32]. One unit in our survey had conducted an internal audit of rt-PA, which also showed a significant reduction in catheter malfunction [33].…”

Antithrombotic Therapy in Neonates and Children

“…525 In the hemodialysis setting, alteplase 1 mg/mL was shown to be more effective than heparin 5,000 units/mL in reducing intraluminal clot between hemodialysis sessions. 526 A multicenter study of 577 pediatric cancer patients with CVADs reported that urokinase administration every 2 weeks reduced both CVAD occlusion rates and catheterrelated infections compared with heparin administration. 527 Most other studies that have reported the use of local thrombolytic agents reported therapy for CVAD blockage and, hence, restoration of patency.…”

The life-threatening hemodialysis catheter heparin lock caused bleeding in a child after peritoneal catheter removal

“…Recently, Gittins et al [22] stated that alteplase is significantly more effective than heparin in preventing clot formation in central haemodialysis lines, what reduces morbidity, and improves preservation of central venous access.…”