Recombinant Tissue Plasminogen Activator (Alteplase) for Restoration of Flow in Occluded Central Venous Access Devices: A Double-Blind Placebo-Controlled Trial—The Cardiovascular Thrombolytic to Open Occluded Lines (COOL) Efficacy Trial

Ponec, Donald; Irwin, David; Haire, William D.; Hill, Patricia A.; Li, Xin; McCluskey, Edward R.

doi:10.1016/s1051-0443(07)61575-9

Cited by 143 publications

(107 citation statements)

References 13 publications

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“…A pivotal study was the COOL (Cardiovascular thrombolytic used to Open Occluded Lines) trial which demonstrated resolution of CVC obstruction in 74% of treatment patients versus only 17% of placebo after 120 min (P<0.0001). 28 Additional studies demonstrated an overall catheter clearance rate of 87%, with 52% being cleared after the first 30 min and even higher rates in treated peripherally inserted central catheters (PICC) line. 29,30 The high efficacy and low risk of alteplase for treating CVC occlusions in adults prompted studies in children.…”

Section: Urokinasementioning

confidence: 99%

“…28-30, 35,36,37-39 Furthermore, overall catheter clearance rates of 95.2% with reteplase suggest that it may be more effective than the other thrombolytics that demonstrate average overall clearance rates ranging from 72 to 86% (Figure 3), though randomized trials making a direct comparison between these agents are needed to confirm this supposition. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] When comparing tenecteplase to the other thrombolytics evaluated, it appears to be of equal or less efficacy after 30 min, with 51.5% clearance in the treatment group compared to the average clearance rates of 52-70% demonstrated with the other thrombolytic medications ( Figure 2). 25 (Figure 3).…”

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

“…25 (Figure 3). [28][29][30]35,36,40,41 When evaluating the efficacy of r-UK, it appears to be more effective than alteplase within the first 30 min, with an average clearance rate of 60% versus 52% for alteplase (Figure 2). 29,30,35,36,[42][43][44] However, none of these trials left r-UK to dwell for more than 30 min.…”

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

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Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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BackgroundLong-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and MethodsThis paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. ResultsAlteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. ConclusionsThrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.

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Section: Urokinasementioning

confidence: 99%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

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Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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“…Para restaurar la permeabilidad de la vía en caso de una oclusión trombótica puede usarse estreptoquinasa, uroquinasa o factor activador del plasminógeno (alteplasa) (12)(13)(14) (GdE 3). Aunque existen otros agentes trombolíticos (alfimeprasa, tenecteplasa) los datos de su empleo en niños son muy limitados (15) (GdE 4).…”

Section: Oclusion Trombóticaunclassified

Complicaciones de la nutrición parenteral pediátrica

Villare¹,

Irastorza

Bozano

2017

Nutr Hosp

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INTRODUCCIÓNPodemos clasificar las complicaciones en cuatro grupos: las relacionadas con el catéter venoso central (CVC); las complicaciones metabólicas; las dependientes de la estabilidad de las soluciones o de las interacciones con fármacos y las psicosociales. La revisión se centra en el paciente pediátrico y no es aplicable en todas sus consideraciones al neonato, especialmente al prematuro. COMPLICACIONES ASOCIADAS A LOS CATÉTERES VENOSOS CENTRALESDentro de estas se incluyen las complicaciones mecánicas (las derivadas de la inserción, la rotura o la obstrucción del catéter y la trombosis venosa) y las infecciones relacionadas con el catéter. COMPLICACIONES EN RELACIÓN CON LA INSERCIÓN DEL CVCLa frecuencia de este tipo de complicaciones es de alrededor del 4% (1). Entre ellas destacan: el neumotórax, el hemotórax, la laceración de un vaso, las arritmias, la perforación cardiaca con taponamiento, el embolismo aéreo, la lesión de un plexo nervioso o la localización anómala del catéter (2). La inserción dirigida por ecografía minimiza el riesgo de complicaciones en la inserción (3) (GdE 1). ROTURA O DESPLAZAMIENTO ACCIDENTALEl CVC puede desplazarse accidentalmente o deliberadamente al tirar de él. Para evitar desplazamientos o retiradas accidentales del catéter es preciso asegurarlo bien, adecuando tanto las medidas de recubrimiento del catéter como las propias vestimentas del niño. Esto es especialmente cierto para los catéteres de larga duración (tunelizados, catéteres venosos centrales de abordaje periférico -PICC-).Con el uso prolongado, el catéter puede deteriorarse y presentar orificios o desgarros. Algunos de los fabricantes de CVC de larga duración disponen de kits de reparación sin necesidad de recambiar todo el catéter. OCLUSIÓN/TROMBOSIS RELACIONADA CON EL CATÉTERExisten tres tipos de complicaciones trombóticas relacionadas con el catéter: la aparición de una vaina de fibrina (fibrin sheat) alrededor de la punta del catéter, la obstrucción en la luz del catéter o una trombosis venosa (4). La oclusión parcial o completa de un CVC limita o impide la posibilidad de extraer sangre o infundir a través del mismo. Puede ocurrir tanto por obstrucción de la luz del catéter como por una compresión externa del catéter o por una malposición del mismo (Tabla I). La incidencia es muy variable, dependiendo de la técnica diagnóstica utilizada, aunque sensiblemente mayor que en la población adulta. En general, las complicaciones trombóticas ocurren en pacientes con dependencia prolongada de la nutrición parenteral (NP), en especial en nutrición parenteral domiciliaria (NPD).Se recomienda infundir suero fisiológico -flushing-(3 a 5 ml) a través del catéter después de la administración de medicaciones o tras la extracción de sangre con el fin de prevenir la oclusión. Las guías de la European Society of Pediatric Gastroenterology/ European Society for Clinical Nutrition and Metabolism (ESPGHAN/ ESPEN) (2005) recomiendan infundir suero salino fisiológico después de la administración de cualquier medicación y la instilaci...

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“…Instillation of a thrombolytic agent (e.g., tissue plasminogen activator [TPA]) should restore a blood return from the port when partial (withdrawal occlusion) or total occlusion occurs. In the Cardiovascular Thrombolytic to Open Occluded Lines (COOL) efficacy trial, alteplase (TPA injection) restored catheter function 90% of the time [6].…”

Section: Best Practices In the Clinic For Thementioning

confidence: 99%

Managing Vesicant Extravasations

Schulmeister¹

2008

The Oncologist

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After completing this course, the reader will be able to:1. Describe how vesicant chemotherapy drugs can extravasate from implanted ports.2. Recommend procedures to obtain a blood return from central venous access devices.3. Evaluate the signs and symptoms of a vesicant extravasation. Administer the FDA-approved vesicant extravasation treatments and antidotes.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit ™ at CME.TheOncologist.com CME CME ABSTRACTExtravasation is an unusual but potentially severe complication of vesicant chemotherapy administration. Some extravasation injuries prompt litigation and the oncologist's actions, or lack of action, are scrutinized in the courtroom. This article presents advice and recommendations for treating patients who receive vesicants and includes a discussion of FDA-approved vesicant extravasation treatments and antidotes. The Oncologist 2008;13:284 -288

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Recombinant Tissue Plasminogen Activator (Alteplase) for Restoration of Flow in Occluded Central Venous Access Devices: A Double-Blind Placebo-Controlled Trial—The Cardiovascular Thrombolytic to Open Occluded Lines (COOL) Efficacy Trial

Cited by 143 publications

References 13 publications

Thrombolytic therapy for central venous catheter occlusion

Thrombolytic therapy for central venous catheter occlusion

Complicaciones de la nutrición parenteral pediátrica

Managing Vesicant Extravasations

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