title: Investigational use of tissue plasminogen activator (t-PA) for occluded central venous catheters.
abstract: Urokinase and streptokinase are commonly used thrombolytic agents for fibrin obstructed central venous catheters. Although proven to be efficacious, these two agents have the potential to induce systemic fibrin breakdown and hemorrhage. We report our initial experience with tissue plasminogen activator (t-PA) for the treatment of occluded central venous catheters which failed urokinase. Of 25 incidents of catheter occlusion in 142 right atrial catheters, six failed to clear after an initial bolus dwell of urokinase. Five of these six catheters cleared following treatment with 2 mg/2 cc of t-PA with a mean of 1.5 bolus installations. The one catheter failure was due to catheter tip position and age of clot. No coagulation abnormalities or bleeding was observed. These data suggest that t-PA may be a safe, effective thrombolytic agent in the treatment of occluded central venous catheters.
authors.affiliation: Division of Pediatric Surgery, Childrens Hospital of Los Angeles, CA 90027.
authors.forename: J B
authors.initials: JB
authors.lastname: Atkinson
authors.forename: H A
authors.initials: HA
authors.lastname: Bagnall
authors.forename: E
authors.initials: E
authors.lastname: Gomperts
mesh_terms: D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D005342:Fibrinolysis / Q000187:drug effects; D006801:Humans; D007223:Infant; D008297:Male; D010865:Pilot Projects; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000494:pharmacology / Q000627:therapeutic use*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000494:pharmacology
chemical_list: D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator