title: Thrombosis of tunneled-cuffed hemodialysis catheters: treatment with high-dose urokinase lock therapy.
abstract: Thrombosis-related malfunction of tunneled-cuffed central venous catheters (TCC) for hemodialysis (HD) currently leads to a high rate of untimely catheter removal. Urokinase (UK) therapy is used for TCC thrombosis/malfunction, but no consensus exists on the adequate dose to obtain thrombolysis. We selected 72 HD patients with TCC and a mean age and HD vintage of 74 years (range 65-87) and 36 months (range 12-61), respectively. All patients received warfarin therapy with a target international normalized ratio (INR) of 1.8-2.5. Coagulative assessment of the patients was obtained by checking the INR, activated partial thromboplastin time, fibrinogen, hemoglobin, and platelets. Sixty-five thrombotic events were recorded during a 3-year follow-up (median 0.3 events/patient/year). The patients selected were randomized into two groups according to a different thrombolytic therapy. Group A comprised 29 thrombotic events in 32 patients who received UK 25,000 IU in both arterial and venous lines of the TCC for each event. UK restored an adequate blood flow rate (BFR) for HD (≥ 250 mL/min) in 4/29 events (13.7%), whereas addition of 50,000 IU to both arterial and venous lines was required in 25/29 events (86.3%). For the same 25 events in the second HD session, a further 75,000 IU of UK was needed for each TCC lumen. Group B comprised 36 thrombotic events in 40 patients who received 100 000 IU of UK in the arterial and venous lumen of the TCC for each event. An adequate BFR was recovered in all events. In 12/36 events (33.3%), 100,000 IU UK for both lumens were needed in the second HD. In conclusion, group B patients obtained (i) a significantly better TCC patency than group A patients; (ii) a low UK administration in the following HD sessions; and (iii) no bleeding complications.
authors.affiliation: Nephrology Dialysis and Renal Transplantation Unit, S.Orsola University Hospital, Bologna, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Donati
authors.forename: Luigi
authors.initials: L
authors.lastname: Colì
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cianciolo
authors.forename: Gaetano
authors.initials: G
authors.lastname: La Manna
authors.forename: Vania
authors.initials: V
authors.lastname: Cuna
authors.forename: Mara
authors.initials: M
authors.lastname: Montanari
authors.forename: Francesco
authors.initials: F
authors.lastname: Gozzetti
authors.forename: Sergio
authors.initials: S
authors.lastname: Stefoni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015996:Survival Rate; D013927:Thrombosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator