A protocol of urokinase infusion and warfarin for the management of the thrombosed haemodialysis catheter.
BACKGROUND
Catheter dysfunction remains a significant cause of catheter loss and interrupted haemodialysis sessions. A number of regimens utilizing urokinase have been used but the optimum management of this common problem remains undetermined.


METHODS
The study took place over 2 years and evaluated a protocol of urokinase infusion (25,000 U in 48 ml saline run at 4 ml/h via each limb of the catheter) followed by warfarin for restoration of catheter patency.


RESULTS
Forty-eight urokinase infusions were used for 41 episodes of catheter dysfunction. Catheter patency was restored in 95% and only one catheter was lost. Recurrent thrombosis occurred in eight of 10 catheters not anticoagulated. Once anticoagulated, catheters worked well. Further episodes of non-function were related to a sub-therapeutic INR.


CONCLUSIONS
Our results show a high success rate for our protocol. We suggest an aggressive approach to the management of catheter thrombosis with urokinase used by infusion and carefully controlled anticoagulation to maintain the INR in the range 2-2.5.
Webb
A
A
Renal Unit, North Staffordshire Royal Infirmary, Princes Road, Hartshill, Stoke-on-Trent, UK. alan.webb@bradfordhospitals.nhs.uk
Abdalla
M
M
Russell
G I
GI
D000925:Anticoagulants / Q000008:administration & dosage; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002985:Clinical Protocols; D006801:Humans; D019934:International Normalized Ratio; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014859:Warfarin / Q000008:administration & dosage*
D000925:Anticoagulants; D014859:Warfarin; D014568:Urokinase-Type Plasminogen Activator