title: Efficacy and economic evaluation of a volume-based cathflo activase protocol versus a fixed-dose alteplase protocol for catheter occlusions in pediatric patients.
abstract: OBJECTIVE
  This prospective study evaluated the efficacy and economic benefit of Cathflo Activase and a volume-dependent protocol versus a previously utilized fixed-dose 2 mg/mL alteplase aliquot protocol for central venous catheter clearance in pediatric patients.
  
  
  METHODS
  All pediatric patients with a medically diagnosed catheter occlusion were eligible for inclusion into this study. Retrospective data was analyzed from an approved data collection form, which had been implemented during the utilization of the alteplase protocol. Data collection indicators included catheter type, dose, dwell time, outcome of attempt (successful or unsuccessful), additional measures taken, and comments. A new protocol utilizing Cathflo Activase and manufacturer recommended volume-based dosing was prospectively implemented and data was collected and evaluated and compared to data from the alteplase protocol.
  
  
  RESULTS
  Alteplase and Cathflo protocol data was evaluated for a total of 96 courses in 48 patients (0.09 - 22.8 years, 2.15 - 105.2 kg). Complete resolution was achieved in 69.6% of patients with the alteplase protocol, partial resolution was attained in 8.7%, and treatment failure occurred in 21.7% of patients. For the Cathflo Activase group, complete resolution was observed in 82% of occlusions, with 8% partial resolution and treatment failure of 10%. The average cost per dose utilized by our patients during this study was $49.68 and $30.56 for the alteplase and Cathflo Activase groups, respectively.
  
  
  CONCLUSIONS
  Our data indicate that the Cathflo Activase protocol may be as efficacious as the previous alteplase protocol. Furthermore, there are added time and cost benefits.
authors.affiliation: Department of Pharmacy, Children's Hospital Boston, Boston, Massachusetts.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Gilarde
authors.forename: Allison M
authors.initials: AM
authors.lastname: Chung
authors.forename: Rosa
authors.initials: R
authors.lastname: Vidal
authors.forename: Sheryl
authors.initials: S
authors.lastname: Falkos
keywords: Cathflo Activase; administration; alteplase; catheter occlusions; pediatrics