title: Use of heparin versus lepirudin flushes to prevent withdrawal occlusion of central venous access devices.
abstract: OBJECTIVE
  To determine whether lepirudin flushes are more effective than heparinized saline in preventing withdrawal occlusion of central venous access devices.
  
  
  METHODS
  Randomized, double-blind clinical trial.
  
  
  METHODS
  Research institution-tertiary referral center.
  
  
  METHODS
  Forty-nine adults undergoing bone marrow transplantation for hematologic malignancies or metastatic solid tumors.
  
  
  METHODS
  Twenty-four patients received heparin and 25 received lepirudin flushes. The heparin dose was 3 ml of porcine heparin 100 U/ml (300 U) per catheter lumen at least once/day; the lepirudin dose was 3 ml of lepirudin 100 microg/ml (300 microg) per catheter lumen at least once/day. After 3-4 weeks, all 49 patients received the heparin flushes.
  
  
  RESULTS
  Efficacy was assessed by the frequency with which the patients were treated with alteplase instillations for withdrawal occlusion of their central venous access devices during the first 4 months of catheterization. Three (12.5%) patients treated with heparin alone and five (20%) treated initially with lepirudin required alteplase instillations for an estimated relative risk with lepirudin versus heparin of 1.6 (95% confidence interval [CI] 0.40-13.86, p=0.70).
  
  
  CONCLUSIONS
  Lepirudin was not more effective than heparin, which may have been related to the conservative dose of lepirudin administered. However, higher lepirudin doses are likely to incur an unacceptable risk of systemic anticoagulation.
authors.affiliation: Department of Laboratory Medicine, W. G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA. mhorne@mail.cc.nih.gov
authors.forename: McDonald K
authors.initials: MK
authors.lastname: Horne
authors.forename: Donna Jo
authors.initials: DJ
authors.lastname: McCloskey
authors.forename: Karim
authors.initials: K
authors.lastname: Calis
authors.forename: Robert
authors.initials: R
authors.lastname: Wesley
authors.forename: Richard
authors.initials: R
authors.lastname: Childs
authors.forename: Claude
authors.initials: C
authors.lastname: Kasten-Sportes
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use*; D006629:Hirudins / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D011994:Recombinant Proteins / Q000009:adverse effects / Q000627:therapeutic use; D013927:Thrombosis / Q000188:drug therapy / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006629:Hirudins; D011994:Recombinant Proteins; D006493:Heparin; D010959:Tissue Plasminogen Activator; C083544:lepirudin