Urokinase for restoring patency of malfunctioning or blocked central venous catheters in children with hemato-oncological diseases.
OBJECTIVE
To evaluate differences in success rate between two dosages of intraluminal urokinase (IL-UK) for treatment of withdraw occlusion in central venous catheters (CVC) and to confirm the efficacy of a salvage protocol with low-dose systemic urokinase (S-UK) in case of failure of IL-UK or of complete catheter obstruction.


METHODS
All malfunctioning or occluded partially implanted indwelling catheters inserted in a 29-month period in children with cancer at two tertiary care centers (Genoa and Turin) in Italy were eligible for this study. In cases of withdraw occlusion, IL-UK was used as first-line treatment with different schedules of administration in the two centers: a 5,000 IU/ml dose was used in Genoa and a 25,000 IU/ml dose in Turin (Protocol A). In case of failure of the front-line protocol or in case of complete CVC occlusion, S-UK at 1,000 IU/kg per hour for 3 h was used as a salvage protocol in both centers (Protocol B).


RESULTS
There were 81 episodes of malfunction and three of occlusion recorded in 68 CVCs. Protocol A was successful in 75 (92.5%) of the malfunction episodes. In particular, the dose of 5,000 IU of IL-UK was successful in 42 (89%) CVCs while the 25,000 IU dose resolved 33 (97%) of the episodes (not significant). The six patients with CVC refractory to IL-UK and the three subjects with complete CVC occlusion were treated with S-UK. Patency was obtained in seven cases (78%); the remaining two catheters had to be removed.


CONCLUSIONS
We found that 5,000 IU of IL-UK were as effective as 25,000 IU to resolve withdrawal occlusion in partially implanted CVCs and that systemic treatment with urokinase may rescue a significant proportion of CVCs refractory to IL-UK or that are apparently completely occluded.
Molinari
Angelo Claudio
AC
Section of Thrombosis and Haemostasis, Department of Pediatric Hematology and Oncology, G. Gaslini Children's Hospital, Genoa, Italy.
Haupt
Riccardo
R
Saracco
Paola
P
Di Marco
Maria
M
Castagnola
Elio
E
Fratino
Giuseppe
G
D000293:Adolescent; D002405:Catheterization, Central Venous; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000188:drug therapy*; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D007223:Infant; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage*; D011446:Prospective Studies; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D014654:Vascular Patency / Q000187:drug effects
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator