title: Recombinant tissue plasminogen activator may reduce frequency of central venous access device infection in hemophilia patients undergoing immune tolerance therapy.
abstract: 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.
authors.affiliation: Comprehensive Hemostasis and Thrombosis Program, Aflac Cancer Center and Blood Disorders Service, Emory University, Atlanta, Georgia, USA. amy.dunn@choa.org
authors.forename: Amy L
authors.initials: AL
authors.lastname: Dunn
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Abshire
mesh_terms: 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*
chemical_list: D000900:Anti-Bacterial Agents; D007518:Isoantibodies; D011994:Recombinant Proteins; C078147:F8 protein, human; D005169:Factor VIII; D005337:Fibrin; D010959:Tissue Plasminogen Activator