Safety and Efficacy of Alteplase for Restoring Function in Occluded Central Venous Catheters: Results of the Cardiovascular Thrombolytic to Open Occluded Lines Trial

Deitcher, Steven R.; Fesen, Mark R.; Kiproff, Paul M.; Hill, Patricia A.; Li, Xin; McCluskey, Edward R.; Semba, Charles P.

doi:10.1200/jco.2002.20.1.317

Cited by 79 publications

(59 citation statements)

References 11 publications

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“…[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. Therefore, the efficacy of r-UK in relation to alteplase at later time points following the first dose remains unclear.…”

Section: Comparison Of Thrombolytic Medicationsmentioning

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%

“…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. Several trials found that alteplase administered for 1-4 h produced catheter clearance rates of 85-95% (Table 2).…”

Section: Urokinasementioning

confidence: 99%

“…After only 30-40 min, catheter clearance rates for reteplase were 67-74% in comparison to the average rates for alteplase (52%), recombinant urokinase (60%) and tenecteplase (52%) (Figure 2). 29,30,35,36,[38][39][40][41][42][43][44] Reteplase also appears to be more effective with longer dwell times and multiple doses. One dose of reteplase resulted in an average catheter clearance rate of 87% with dwell times of as little as 60 min compared to 76% average clearance with alteplase after twice as long (120 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: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

Section: Urokinasementioning

confidence: 99%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

See 2 more Smart Citations

Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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“…163 In a phase 2 multicenter, randomized, double-blind study (NuCath), alfimeprase (1 mg and 3 mg) restored 50% catheter patency in comparison with 0% for Cathflo Ò Activase Ò (Genentech) at 15 min without any hemorrhagic events. 164 From the venom of the snake Vipera lebetina, a direct fibrinolytic enzyme with low hemorrhagic activity, Lebetase, has been isolated. 165 A fibrinolytic enzyme (lumbrokinase) from the earthworm Lumbricus rubellus was isolated in 1991.…”

Section: Direct Thrombolytic Agentsmentioning

confidence: 99%

The evolution of recombinant thrombolytics: Current status and future directions

Adivitiya

Khasa

2016

Bioengineered

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Cardiovascular disorders are on the rise worldwide due to alcohol abuse, obesity, hypertension, raised blood lipids, diabetes and age-related risks. The use of classical antiplatelet and anticoagulant therapies combined with surgical intervention helped to clear blood clots during the inceptive years. However, the discovery of streptokinase and urokinase ushered the way of using these enzymes as thrombolytic agents to degrade the fibrin network with an issue of systemic hemorrhage. The development of second generation plasminogen activators like anistreplase and tissue plasminogen activator partially controlled this problem. The third generation molecules, majorly t-PA variants, showed desirable properties of improved stability, safety and efficacy with enhanced fibrin specificity. Plasmin variants are produced as direct fibrinolytic agents as a futuristic approach with targeted delivery of these drugs using liposome technlogy. The novel molecules from microbial, plant and animal origin present the future of direct thrombolytics due to their safety and ease of administration.

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Interventions for restoring patency of occluded central venous catheter lumens

Miert

Hill

Jones

2012

Cochrane Database of Systematic Reviews

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There is inadequate evidence to draw strong conclusions on the efficacy or safety of the drug interventions included in this review. There is some low quality evidence from a meta-analysis of two studies investigating urokinase (various strengths) and some very low evidence from two single studies investigating alteplase 2 mg/2 mL that suggest that these two drug interventions may be effective in treating withdrawal or total occlusion of CVC lumens caused by thrombosis. Further high quality, sufficiently powered research is still required to look at the efficacy and safety of urokinase, alteplase and other chemical, surgical and drug interventions for treating CVC lumen occlusion. Research studies which exclusively include child participants are especially warranted.

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Safety and Efficacy of Alteplase for Restoring Function in Occluded Central Venous Catheters: Results of the Cardiovascular Thrombolytic to Open Occluded Lines Trial

Abstract: A regimen of up to two 2-mg doses of TPA is safe and effective for the restoration of flow to occluded central venous catheters.

Cited by 79 publications

References 11 publications

Thrombolytic therapy for central venous catheter occlusion

Thrombolytic therapy for central venous catheter occlusion

The evolution of recombinant thrombolytics: Current status and future directions

Interventions for restoring patency of occluded central venous catheter lumens

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