Monthly recombinant tissue plasminogen activator administration to implantable central venous access devices decreases infections in children with haemophilia

Abstract

Central venous access devices (CVAD) have been effectively used in the care of haemophilia patients. This is particularly true in children, who often have difficult venous access. CVAD complications (infection and thrombosis), risk factors, and complication rates, have been well-documented. However, effective interventions which decrease complication rates have not been identified. In this study, we review our experience with the use of monthly recombinant tissue plasminogen activator (rtPA) administration in haemophilia patients with fully implanted CVADs. Data on 19 haemophilia patients with 24 CVADs were available for analysis, with a total of 24 520 CVAD days. An infection rate of 0.04 infections per 1000 CVAD days and a thrombosis rate of 0.04 thrombi per 1000 CVAD days was observed. The observed infectious complication rate is at least one logarithm lower than many published CVAD infection rates in haemophilia patients who have not received rtPA administration. No bleeding complications were noted. Monthly rtPA is safe and appears to be effective in decreasing CVAD infection rates. Larger, randomized controlled studies are indicated to validate this finding.

Updated analysis: central venous access device infection rates in an expanded cohort of paediatric patients with severe haemophilia receiving prophylactic recombinant tissue plasminogen activator

“…The rate of CVAD thrombosis observed in this study [0.09 (0.02-0.22) per 1000 CVAD days], was similar to the previously published thrombosis rate of 0.06 (0.01-0.19) per 1000 CVAD days [17]. This rate also did not differ significantly from those observed amongst patients with haemophilia not receiving r-tPA prophylaxis [0.056 (0.016-0.196)] [6].…”

“…Patient 25 had vascular abnormalities of the superior vena cava that were thought to contribute to his catheter dysfunction. A CVAD with a noted manufacturer malfunction contributed to the complications experienced by patient 27 [17]. One patient experienced two complications.…”

“…In our previous study, we performed a review of the medical literature in order to determine a baseline CVADassociated infection rate in haemophilic patients with characteristics similar to our patient population [17]. Three publications included individual patient data, allowing for the pooling of data on 63 subjects with 73 CVADs, with a total of 54 574 CVAD days.…”

“…In another case, no cause could be identified to explain the cause of CVAD dysfunction, even after surgical removal. As mentioned above, the malfunctions of Patient 27's initial CVADs were later attributed to a manufacturer malfunction [17]. Factor VIII Immune tolerance Asian 9.8 1643 31…”

Complications associated with central venous access device in children with haemophilia: a nationwide multicentre study in Finland

“…Non‐infectious complications were the most common reason for CVAD removal. Incidence of mechanical complications is similar to previously reported , but the malfunction rate seems to be higher than that previously reported . When comparing to the findings of a meta‐analysis , CVADs remained in situ for twice as long; the median life span was 1159 days (3.2 years) in our cohort compared to 578 days (95% CI 456–733 days) in the meta‐analysis.…”