title: Prophylactic urokinase in the management of long-term venous access devices in children: a Children's Oncology Group study.
abstract: OBJECTIVE
  Infection and thrombosis are serious complications of long-term vascular access devices in children undergoing chemotherapy. Since routine fibrinolytic therapy may decrease these complications, the purpose of this study was to compare the efficacy of an every-2-week administration of urokinase with standard heparin flushes in reducing the incidence of device-related infections and occlusions.
  
  
  METHODS
  This study was a prospective, randomized phase III multicenter trial conducted by the Children's Cancer Group, in which patients with implantable ports or tunneled catheters received either urokinase or heparin every 2 weeks for 12 months. Study end points were time to first occlusion or time to first device-related infection.
  
  
  RESULTS
  Five hundred seventy-seven patients from 29 institutions were enrolled, of whom 51% had external catheters and 49% had ports. Urokinase administration resulted in fewer occlusive events than heparin (23% v 31%; P =.02), a longer time to first occlusive event (log-rank analysis, P =.006), and a 1.6-fold difference in the rate of occlusive events (Poisson regression, P =.003). Similar results were noted when comparing ports and tunneled catheters. The urokinase group also had a 1.4-fold difference in the rate of infection (Poisson regression, P =.05) and longer time to first infection (log-rank, P =.07), but the difference was significant only in tunneled catheters.
  
  
  CONCLUSIONS
  Urokinase administration every 2 weeks significantly affects the rate of occlusive events in ports and tunneled catheters and of infectious events in external catheters compared with heparin administration.
authors.affiliation: Department of Surgery, Division of Pediatric Surgery, Penn State College of Medicine, Hershey, PA 17033, USA. pdillon1@psu.edu
authors.forename: Peter W
authors.initials: PW
authors.lastname: Dillon
authors.forename: Gary R
authors.initials: GR
authors.lastname: Jones
authors.forename: Holly A
authors.initials: HA
authors.lastname: Bagnall-Reeb
authors.forename: Jonathon D
authors.initials: JD
authors.lastname: Buckley
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Wiener
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Haase
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D008297:Male; D009369:Neoplasms / Q000188:drug therapy; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D013927:Thrombosis / Q000517:prevention & control*; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator