Efficacy of urokinase lock to treat thrombotic dysfunction of tunneled hemodialysis catheters: A retrospective cohort study

Hulle, Freya Van; Bonkain, Florence; Clerck, Dieter De; Aerden, Dimitri; Vanwijn, Isabelle; Tielemans, Christian; Wissing, Karl Martin

doi:10.1177/1129729818779549

Cited by 7 publications

(9 citation statements)

References 33 publications

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“…Both Al-Ali et al and Winnichi et al report reduced rates of all-causes catheter exchange concluding that Taurolock/U is a safe and effective lock solution for tunneled dialysis catheters (Al-Ali et al, 2017;Winnicki et al,2017). These results were also corroborated by the studies of Bonkain et al and Van Hulle et al who report that urokinase locks are significantly efficient in preventing thrombotic dysfunction or restoring catheter functionality (Bonkain et al, 2017;Van Hulle et al, 2019). Finally, Wang et al in their combined in vivo and in vitro study on hemodialysis catheter locks demonstrated that uPA locks have superior anti-thrombotic and anti-biofilm properties comparing to heparin locks while uPA combined with antibiotics also offers enhanced antimicrobial protection (Wang et al, 2020).…”

Section: Discussionmentioning

confidence: 63%

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

Skoulatou¹,

Alikari²,

Toulia³

et al. 2021

GJHS

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INTRODUCTION: Hemodialysis patientsare at increased risk of catheter-related bloodstream infections (CRBSI) and catheter thrombosis asdialysis requires regular access to blood circulation through catheters. Antimicrobial Locking Solutions (ALS) containing anticoagulants and antimicrobial agents (antibiotic/non-antibiotic) are used to seal catheters in order to prevent thrombosis and CRBSI. PURPOSE: The investigation of internationalclinical studies regarding the efficacy and safety of the various ALS treatments for CRBSI in hemodialysis patients (HD patients) comparing to conventional approaches such as heparin treatment or catheter removal. METHODOLOGY: The review included prospective or retrospective clinical studies, randomized clinical trials or cohort studies published since 2015. Publications were retrieved from the “Pubmed”, “Google Scholar” and “Elsevier” databases using ‘catheter’, ‘catheter removal’, ‘hemodialysis’ ‘bacteremia’, ‘antimicrobial lock therapy’as key words. RESULTS: 17 articles were found to meet the criteria for this systematic review. These studies investigated locking solutions containing various antibiotic (Cefazolin, Gentamicin, Vancomycin, Cotrimoxazole, Daptomycin, Trimethoprim) or/and non-antibiotic agents (Citrate, taurolidine, ethanol, urokinase, Cathasept) +/- anticoagulants, single or in various combinations. The main objective of these studies was to identify the efficacy of ALS with respect to CRBSI risk rates, catheter exchange rates and related adverse effects. CONCLUSIONS: Antimicrobial Locking Therapy appears significantly beneficial forHD patients as it reduces CRBSI risk and prolongs catheter survival at considerable rates, so it should be seriously considered for systematic useagainst catheter-related infections. Further researchis required to establish safe and effective prevention and therapeutic protocols as alternatives to catheter removal practices.

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Section: Discussionmentioning

confidence: 63%

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

Skoulatou¹,

Alikari²,

Toulia³

et al. 2021

GJHS

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“…Instead, it is widely used for thrombolytic therapy of deep venous thrombosis, peripheral arterial occlusive disease, and pulmonary embolism [ 48 , 67 , 68 ], as described previously. It was also found to be effective for the restoration of patency in intravenous catheters occluded by clotted blood [ 69 ].…”

Section: Development Of Novel Thrombolyticsmentioning

confidence: 99%

“…It was also found to be effective for the restoration of patency in intravenous catheters occluded by clotted blood. 69 Alteplase has a short plasma half-life (approximately 6 minutes), but it was shown to be effectively (approximately 550fold) stimulated by fibrin. 70 In fibrin-bound plasminogen, the target peptide bond becomes available because of conformational changes after lysine-dependent binding to fibrin.…”

Section: Shortcomings Of Current Thrombolyticsmentioning

confidence: 99%

Development and Testing of Thrombolytics in Stroke

Nikitin¹,

Choi

Mičan³

et al. 2021

J Stroke

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Despite recent advances in recanalization therapy, mechanical thrombectomy will never be a treatment for every ischemic stroke because access to mechanical thrombectomy is still limited in many countries. Moreover, many ischemic strokes are caused by occlusion of cerebral arteries that cannot be reached by intra-arterial catheters. Reperfusion using thrombolytic agents will therefore remain an important therapy for hyperacute ischemic stroke. However, thrombolytic drugs have shown limited efficacy and notable hemorrhagic complication rates, leaving room for improvement. A comprehensive understanding of basic and clinical research pipelines as well as the current status of thrombolytic therapy will help facilitate the development of new thrombolytics. Compared with alteplase, an ideal thrombolytic agent is expected to provide faster reperfusion in more patients; prevent re-occlusions; have higher fibrin specificity for selective activation of clot-bound plasminogen to decrease bleeding complications; be retained in the blood for a longer time to minimize dosage and allow administration as a single bolus; be more resistant to inhibitors; and be less antigenic for repetitive usage. Here, we review the currently available thrombolytics, strategies for the development of new clot-dissolving substances, and the assessment of thrombolytic efficacies <i>in vitro</i> and <i>in vivo</i>.

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“…Refractory thrombosis results in persistent catheter dysfunction and requires TCC removal in one third of the patients [ 8 , 25 ]. Despite high efficacy of thrombolytic agents to dissolve the existing thrombus, recurring catheter thrombosis remains associated with worse long-term catheter survival [ 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…Improved catheter survival and improved cost-effectiveness were largely driven by prevention of CRBSI in both controlled trials [ 27 , 28 ]. In most modern HD units however, the incidence of CRBSI in chronic patients in the maintenance phase is well below 1/1000 catheters days at risk [ 26 , 30 ]. In this population, the efficacy of universal primary prevention with thrombolytic locks is uncertain, and a more cost-effective approach might therefore consist in their use in catheters with a documented history of recurring TD.…”

Section: Introductionmentioning

confidence: 99%

Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial

et al. 2021

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Background The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. Methods Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function. Results 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23–0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis. Conclusions Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis. Trial registration ClinicalTrials.gov Identifier: NCT02036255.

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Efficacy of urokinase lock to treat thrombotic dysfunction of tunneled hemodialysis catheters: A retrospective cohort study

Cited by 7 publications

References 33 publications

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

Development and Testing of Thrombolytics in Stroke

Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial

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