title: Review and update of the use of urokinase in the prevention and management of CVAD-related complications in pediatric oncology patients.
abstract: Pediatric oncologists from Germany systematically reviewed the literature, considering the use of urokinase in pediatric oncology patients published since 1998 and came to the following conclusions. The use of urokinase to prevent central venous access device (CVAD)-related infections in pediatric cancer patients represents an evidence-based approach, at least in external, tunneled catheters (eg, Hickman, Broviac). The effectiveness of urokinase prophylaxis in decreasing infections and thrombotic events is probably related not only to the concentration and timing of the urokinase intervention but also to the type of CVAD, and perhaps to the intensity of the concomitant chemotherapy program. Urokinase can safely and effectively be used on CVADs with malfunctioning or intraluminal occlusion in a dose of 5000 IU/mL or as salvage 3-hour infusion with 1000 IU/kg/hour. Hitherto, adjuvant treatment with urokinase in the management of CVADs with intraluminal infection still relies on case reports and small case series. In this field, a randomized controlled study is necessary.
authors.affiliation: Department of Pediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Bonn, Germany. asimon@ukb.uni-bonn.de
authors.forename: Arne
authors.initials: A
authors.lastname: Simon
authors.forename: Udo
authors.initials: U
authors.lastname: Bode
authors.forename: Kerstin
authors.initials: K
authors.lastname: Lieber
authors.forename: Karin
authors.initials: K
authors.lastname: Beutel
authors.forename: Gudrun
authors.initials: G
authors.lastname: Fleischhack
mesh_terms: D001777:Blood Coagulation / Q000187:drug effects*; D002405:Catheterization, Central Venous / Q000379:methods*; D002408:Catheters, Indwelling / Q000382:microbiology; D018890:Chemoprevention / Q000379:methods / Q000706:statistics & numerical data*; D002648:Child; D003428:Cross Infection / Q000517:prevention & control*; D005858:Germany; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000188:drug therapy; D014568:Urokinase-Type Plasminogen Activator / Q000494:pharmacology*
chemical_list: D014568:Urokinase-Type Plasminogen Activator