Post-operative intracranial hemorrhage related to using t-PA for declotting an occluded hemodialysis catheter: A cautionary tale.
Heparin and thrombolytic agents such as tissue plasminogen activator (t-PA) are frequently used to prevent and treat occluded hemodialysis (HD) catheters. Thrombolytic agents have not been well studied for systemic effects. We present a post-operative neurosurgical patient who experienced a symptomatic intracranial hemorrhage (ICH) after t-PA was used to treat an occluded HD catheter. This case highlights that using t-PA to treat dysfunctional catheters may be associated with ICH in neurosurgical patients. Management strategies are discussed with a review of pertinent literature.
Department of Neurosurgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA. Electronic address: jillian_h_plonsker@rush.edu.
Jillian
J
Plonsker
Department of Neurosurgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA.
Lee A
LA
Tan
Department of Neurosurgery, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612, USA.
Lorenzo F
LF
Munoz
D000368:Aged; D061807:Catheter Obstruction; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D011183:Postoperative Complications / Q000188:drug therapy; D019106:Postoperative Hemorrhage / Q000139:chemically induced*; D011184:Postoperative Period; D006435:Renal Dialysis; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects* / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
HD catheters; Hemodialysis; Intracranial hemorrhage; Neurosurgery; Post-operative hemorrhage; t-PA