Recombinant tissue plasminogen activator is a useful alternative to heparin in priming Quinton Permcath

Schenk, Peter; Rosenkranz, Alexander R.; Wölfl, Gabriele; Hörl, Walter H.; Traindl, O

doi:10.1016/s0272-6386(00)70311-8

Cited by 54 publications

(48 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is similar to the experience of other workers [16,17]. Side effects to rtPA use, the commonest of which is bleeding at sites of tissue injury, and the most serious being intracranial hemorrhage [16,17], have only been reported with the administration of high doses (>1.5 mg/kg) during endovascular surgery and in association with significant co-morbidity such as stroke and malignancy [17]. The remarkable safety profiles and short half-life of rtPA allowed for its use even in the absence of a definitive cause of catheter dysfunction.…”

Section: Discussionsupporting

confidence: 92%

“…It can be easily and promptly administered upon detection of catheter dysfunction in the dialysis unit. Although side effects are rare at low doses [15,16,17], skilled dialysis medical staffs that are familiar with the patient's medical history are readily available to monitor its administration and respond to any complication that might arise. The risks from general anesthesia and surgery are substantially reduced, as is the requirement for hospitalization.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance

et al. 2005

View full text Add to dashboard Cite

Hemodialysis (HD) catheter occlusion is a common cause of poor blood flow and inadequate dialysis. In order to address this problem in our pediatric dialysis unit, we elected to use short (2-h) infusions of low-dose recombinant tissue plasminogen activator (rtPA) for thrombolysis of occluded catheters. Catheters meeting diagnostic criteria for thrombosis were infused with 2.5 mg rtPA in 25 ml 0.9 normal saline over 2 h prior to dialysis. Retrospective data collection was carried out to assess the success of this procedure. Variables assessed included blood flow (Qb), transmembrane pressure (TMP) and venous pressure (VP) before and after rtPA infusion. Seven catheter thromboses in six patients were successfully treated with rtPA; there were significant improvements in Qb ( p <0.01), TMP ( p <0.01), and VP ( p <0.02). At 32 weeks after rtPA therapy, Kaplan-Meier survival analysis showed a 60% probability of primary catheter patency. At the end of the study, 85% of catheters had adequate function as defined by a Qb >200 ml/min. No adverse events were observed. Low-dose rtPA infusion is safe and effective for catheter thrombolysis in outpatient pediatric HD patients. It may serve as an alternative method of administration to local instillation and may be used to restore patency before resorting to surgical revisions.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance

et al. 2005

View full text Add to dashboard Cite

show abstract

“…Low concentration citrate or tissue plasminogen activator (tPA) have both been shown to be safe alternatives, and would be indicated in HIT patients with intravascular devices, such as a catheter used for hemodialysis [29][30][31].…”

Section: Resultsmentioning

confidence: 99%

A Case Review: Anticoagulation in Hemodialysis Patients with Heparin-Induced Thrombocytopenia

Chuang¹,

Parikh

Reilly

2001

Am J Nephrol

View full text Add to dashboard Cite

We describe a patient with acute renal failure who subsequently developed heparin-induced thrombocytopenia (HIT) while on hemodialysis. Heparin was immediately discontinued and alternative modes of anticoagulation were considered as further hemodialysis was indicated. With several options available, a review of the current literature was performed to aid in the selection of the most appropriate method. We conclude that there is currently no ideal hemodialysis anticoagulation agent for a patient with HIT. Among the currently available alternatives, no anticoagulation or regional citrate infusion during hemodialysis appears to be the most reliable and safest option for these patients. Based upon its safety, reversibility, low cost and availability, a trial of warfarin also may be attempted for hemodialysis anticoagulation. Both danapranoid and lepirudin have been used effectively in hemodialysis patients with HIT, but have the disadvantage of prolonged half-lives in patients with renal failure and relatively high cost.

show abstract

“…A prospective, randomized, crossover study compared 2 ml of recombinant tPA with 2000 units of heparin per ml (36). The recombinant tPA group had better flow and fewer complications, but the sample size was small and follow-up was limited.…”

Section: Changes In Blood Flow: the Use Of Catheter-locking Solutionsmentioning

confidence: 99%

Interventional Nephrology

Niyyar

Chan

2013

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryDespite recommendations by various national guidelines advocating arteriovenous fistulae as the access of choice in patients undergoing hemodialysis (HD), the use of central venous catheters (CVCs) remains widespread among both incident and prevalent HD patients. Unfortunately, long-term use of CVCs is fraught with complications, which are a major cause of morbidity and death in this patient population. Complications include a high rate of infections, as well as thrombus and sheath-related mechanical dysfunction. This review addresses prevention and management of noninfectious catheter-related dysfunction.

show abstract

Recombinant tissue plasminogen activator is a useful alternative to heparin in priming Quinton Permcath

Cited by 54 publications

References 21 publications

Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance

Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance

A Case Review: Anticoagulation in Hemodialysis Patients with Heparin-Induced Thrombocytopenia

Interventional Nephrology

Contact Info

Product

Resources

About