Repeated low–dose streptokinase infusions into occluded permanent, central–venous hemodialysis catheters

Welik, Robert; Josselson, John; Shen, Steve Y.; Reed, William R.; Sadler, John H.

doi:10.1038/ki.1987.130

Cited by 11 publications

(9 citation statements)

References 14 publications

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“…74,75 Urokinase and strepokinase therapy From 1987 to 1998, 14 clinical trials evaluating either urokinase and/or streptokinase were published. 18,[76][77][78][79][80][81][82][83][84][85] Urokinase (5000-9000 U) was used as either a CVC lock or as a systemic infusion (250,000 U). 18,76,[77][78][79][80][81] The success or recanalization rate was between 74-100%, with the exception of one study that reported only 14% success.…”

Section: Treatment Of Catheter Malfunction Intraluminal Causes Of Malfunction: Thrombosismentioning

confidence: 99%

Traditional and non-traditional strategies to optimize catheter function: go with more flow

Mokrzycki

2010

Kidney International

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In the United States, over 340,000 patients have end-stage renal disease treated by hemodialysis (HD) and are dependent on a reliable vascular access. In over 80% of patients initiating HD, this access is the central venous catheter (CVC). Although the CVC has many advantages that make it desirable for dialysis initiation-ease of insertion, unnecessary maturation time, and availability for immediate use-it is not without significant disadvantages. The substantial morbidity and mortality associated with CVC use has been well documented in the literature. Initiating and maintaining HD patients using a CVC is suboptimal from the perspective of both patient care and associated long-term costs. Yet, in the United States, the most common HD access-related event is replacement of any vascular access type with a CVC. Although in recent years greater effort has be made to reduce CVC use, some patients are unable to have a functioning arteriovenous fistula or graft created due to exhaustion of vessels from previous permanent accesses or limiting comorbidities. In patients dependent on long-term CVC use, the primary problems are due to malfunction ('poor flows') or infection. Catheter malfunction leads to inadequate dialysis, the need for costly and inconvenient intervention, and reduced quality of life. This review will focus on the etiology, prevention, and management of CVC-related malfunction.

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Section: Treatment Of Catheter Malfunction Intraluminal Causes Of Malfunction: Thrombosismentioning

confidence: 99%

Traditional and non-traditional strategies to optimize catheter function: go with more flow

Mokrzycki

2010

Kidney International

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“…In comparison, Streptokinase was given 250000 units in each lumen, making a total of 500000 units. 13,14 Success in thrombolysis and restoration of functioning of the catheter was defined as flow rate achieved more than 200ml/min. Characteristics of participants and the distribution of the patients with successful thrombolysis of the catheter were described using descriptive statistics.…”

Section: Methodsmentioning

confidence: 99%

Comparison of Streptokinase and Urokinase for Thrombolysis in Blocked Tunnel Cuffed Catheter Among the Patients of Chronic Renal Failure Undergoing Hemodialysis

Tahir

Raja

Azam

et al. 2022

PAFMJ

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Objective: To compare the efficacy of Streptokinase and Urokinase for thrombolysis in blocked tunnel cuffed catheter among the patients with chronic renal failure undergoing hemodialysis. Study Design: Comparative prospective study. Place and Duration of Study: Department of nephrology Pak Emirates Military Hospital Rawalpindi Pakistan, from Aug 2019 to Mar 2020. Methodology: A total of 100 cases were included in the study which was undergoing hemodialysis in the nephrology department and had a poorly functioning or blocked tunnel cuffed catheter. These patients were either given Urokinase or Streptokinase in standard doses for thrombolysis. The lottery method was used to designate the patient either in the Streptokinase or Urokinase groups. The primary endpoint was the resolution of blocking and regain of proper functioning of the catheter. Results: In our study, 54 (54%) patients were males, and 46 (46%) were females. The mean age of the study participants was 44.63 ± 3.782 years, and the mean duration of chronic kidney disease was 2.19 ± 6.814 years. 43 (43%) patients were given Urokinase, while 57 (57%) were given Streptokinase. After applying the logistic regression, we found that the use of Streptokinase had a significant association with the resolution of blocking and regain of proper functioning of the catheter compared to the use of Urokinase. Conclusion: This study concluded that most catheters regain the proper functioning after thrombolysis with either Urokinase or Streptokinase. However, Streptokinase emerged as a better agent for this purpose in our study.

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“…As choices become limited, it seems likely that thrombotic epi sodes will be repeated. Streptokinase has a reputation for antigenicity and even anaphy laxis when used repeatedly for the same sub ject [20], Yet Welik et al [21] have used repeated low-dose infusions of streptokinase into occluded central venous hemodialysis catheters without any apparent negative ef fects. Nevertheless, if patients have to be subjected to repeated courses of prolonged local thrombolytic infusion therapy, it may be wiser to use urokinase rather than strepto kinase.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Subclavian Vein Thrombosis Occurring in Association with Subclavian Cannulation for Hemodialysis

et al. 1989

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With the aim of improving the diagnosis and treatment of subclavian vein thrombosis, associated with subclavian cannulation for hemodialysis, we performed Doppler examination of the subclavian vein and clinical inspection of the ipsilateral arm at every dialysis in 50 consecutive patients who received subclavian hemodialysis catheters over 1 year. Edema of the arm and disappearance of the subclavian vein bruit correctly detected 3 cases of subclavian vein obstruction which were confirmed by X-ray venograms. All 3 cases failed to respond to systemic heparin, but were successfully recanalized within 36 h with continuous local streptokinase infusion at a rate of 10,000 U in 1 ml/h. In 4 other cases of edema of the arm, Doppler examination correctly predicted patency of the vein, also confirmed radiologically. In 2 cases of thrombosis, there was an underlying stenosis of the left innominate vein close to its union with the superior vena cava. These were dilated by balloon angioplasty; the stenosis recurred in both cases without recurrent thrombosis, and the angioplasty was repeated. Doppler surveillance seems to be a promising aid to the detection of subclavian vein thrombosis from hemodialysis catheters. Local streptokinase infusion is effective in treating thrombosis. Underlying venous stenosis should be looked for because this may be at least partly remediable by balloon angioplasty.

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Repeated low–dose streptokinase infusions into occluded permanent, central–venous hemodialysis catheters

Cited by 11 publications

References 14 publications

Traditional and non-traditional strategies to optimize catheter function: go with more flow

Traditional and non-traditional strategies to optimize catheter function: go with more flow

Comparison of Streptokinase and Urokinase for Thrombolysis in Blocked Tunnel Cuffed Catheter Among the Patients of Chronic Renal Failure Undergoing Hemodialysis

Diagnosis and Management of Subclavian Vein Thrombosis Occurring in Association with Subclavian Cannulation for Hemodialysis

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