title: Effective use of alteplase for occluded tunneled venous catheter in hemodialysis patients.
abstract: Despite their propensity for significant infectious and mechanical complications, tunneled central venous catheters (CVCs) have become a common means of vascular access in the world for patients requiring chronic hemodialysis for end-stage renal disease. The objective of this study was to explore if cryopreserved solutions of the thrombolytic agent alteplase could be used as an effective, safe, and economically reasonable alternative in hemodialysis patients with occluded tunneled CVC. Patients requiring chronic hemodialysis and presenting with occluded tunneled CVC received a sufficient volume of the alteplase solution to fill the occluded catheter. To make alteplase economically feasible, it was diluted to 1-mg/mL aliquots and they were stored at -20°C until use. Eighty-one patients accounting for 179 attempted clearances were assessable for efficacy. One hundred forty-seven (82.1%) of the 179 catheter clearance attempts resulted in successful catheter clearance after one dose. Twenty-seven (15.1%) of all occluded CVCs were successful after two doses whereas five (2.8%) were not. No adverse events were reported. Cryopreserved 1-mg/mL aliquots of alteplase are safe and effective in the clearance of occluded CVC for hemodialysis patients.
authors.affiliation: Internal Medicine, University of São Paulo State-Botucatu School of Medicine-UNESP, Botucatu, São Paulo, Brazil.
authors.forename: Marcela L
authors.initials: ML
authors.lastname: Mendes
authors.forename: João H
authors.initials: JH
authors.lastname: Castro
authors.forename: Tricya N
authors.initials: TN
authors.lastname: Silva
authors.forename: Pasqual
authors.initials: P
authors.lastname: Barretti
authors.forename: Daniela
authors.initials: D
authors.lastname: Ponce
mesh_terms: D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000295:instrumentation*; D013927:Thrombosis / Q000517:prevention & control*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014654:Vascular Patency / Q000187:drug effects*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Alteplase; Hemodialysis; Thrombosis; Tunneled central venous catheter