Recombinant tissue plasminogen activator may reduce frequency of central venous access device infection in hemophilia patients undergoing immune tolerance therapy.
Many patients with hemophilia, particularly those with inhibitory antibodies, utilize central venous access devices (CVADs) to facilitate frequent infusions. Infection of these devices is a common complication of factor replacement therapy. This communication reports our center's experience with CVAD infection in three patients with severe hemophilia A undergoing immune tolerance therapy (ITT) in whom intermittent infusions of recombinant tissue plasminogen activator (rTPA, Cathflo Activase) were utilized. In this small experience, patients experienced a decreased frequency of gram-positive infections when receiving routine rTPA treatments. Larger randomized trial should be performed in this patient population at high risk of CVAD infection.
Dunn
Amy L
AL
Comprehensive Hemostasis and Thrombosis Program, Aflac Cancer Center and Blood Disorders Service, Emory University, Atlanta, Georgia, USA. amy.dunn@choa.org
Abshire
Thomas C
TC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002675:Child, Preschool; D003888:Desensitization, Immunologic; D004198:Disease Susceptibility; D004341:Drug Evaluation; D005169:Factor VIII / Q000276:immunology / Q000627:therapeutic use; D005337:Fibrin / Q000096:biosynthesis; D005342:Fibrinolysis; D006467:Hemophilia A / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007518:Isoantibodies / Q000276:immunology; D011994:Recombinant Proteins / Q000627:therapeutic use; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D007518:Isoantibodies; D011994:Recombinant Proteins; C078147:F8 protein, human; D005169:Factor VIII; D005337:Fibrin; D010959:Tissue Plasminogen Activator