title: Thrombolytic therapy for central venous catheter occlusion.
abstract: BACKGROUND
  Long-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal.
  
  
  METHODS
  This paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed.
  
  
  RESULTS
  Alteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group.
  
  
  CONCLUSIONS
  Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.
authors.affiliation: Division of Hematology and Oncology, Children’s Hospital Los Angeles, Los Angeles, CA 90027, USA. jbaskin13@hotmail.com
authors.forename: Jacquelyn L
authors.initials: JL
authors.lastname: Baskin
authors.forename: Ulrike
authors.initials: U
authors.lastname: Reiss
authors.forename: Judith A
authors.initials: JA
authors.lastname: Wilimas
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.forename: Raul C
authors.initials: RC
authors.lastname: Ribeiro
authors.forename: Ching-Hon
authors.initials: CH
authors.lastname: Pui
authors.forename: Scott C
authors.initials: SC
authors.lastname: Howard
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D015912:Thrombolytic Therapy; D020246:Venous Thrombosis / Q000209:etiology* / Q000628:therapy*
chemical_list: D005343:Fibrinolytic Agents