Recombinant urokinase is safe and effective in restoring patency to occluded central venous access devices: A multiple-center, international trial*?

Svoboda, Petr; Barton, R. P. E.; Barbarash, O. L.; Butylin, Alexey A.; Jacobs, Brian R.; Lata, Jan; Haire, William D.; Jaff, Michael R.; Firszt, Carolyn M.; Mouginis, Tamyra L.; Schuerr, Debra M.; Schulz, Gregory A.; Schwartz, Lewis B.; El-Shahawy, Mohamed

doi:10.1097/01.ccm.0000142706.01717.eb

Cited by 49 publications

(37 citation statements)

References 13 publications

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“…[28][29][30][35][36][37][38][39][40][41][42][43][44][45] In this study, the clearance rates for alteplase were significantly lower than those found in several other studies, a finding that makes interpretation of the study difficult (13 patients received alteplase in the Moll et al trial vs. 122 to 955 patients in other studies with alteplase). [28][29][30]35,36,45 Alfimeprase has a rapid onset of action, but a second dose may be required after a short period of time for maximum efficacy.…”

Section: Comparison Of Thrombolytic Medicationscontrasting

confidence: 53%

“…[28][29][30]35,36,40,41 When evaluating the efficacy of r-UK, it appears to be more effective than alteplase within the first 30 min, with an average clearance rate of 60% versus 52% for alteplase (Figure 2). 29,30,35,36,[42][43][44] However, none of these trials left r-UK to dwell for more than 30 min. Therefore, the efficacy of r-UK in relation to alteplase at later time points following the first dose remains unclear.…”

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

“…28-30, 35,36,37-39 Furthermore, overall catheter clearance rates of 95.2% with reteplase suggest that it may be more effective than the other thrombolytics that demonstrate average overall clearance rates ranging from 72 to 86% (Figure 3), though randomized trials making a direct comparison between these agents are needed to confirm this supposition. [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] When comparing tenecteplase to the other thrombolytics evaluated, it appears to be of equal or less efficacy after 30 min, with 51.5% clearance in the treatment group compared to the average clearance rates of 52-70% demonstrated with the other thrombolytic medications ( Figure 2). 25 (Figure 3).…”

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

“…Recent studies have demonstrated that r-UK, at a dose of 5000 IU/mL, was effective and safe, with 54-75% of occlusions cleared after up to 2 treatments, each lasting 30 min, and minimal adverse events in the subsequent 72 h (Table 2). 42,43 In a dose-range study, it was found that higher doses do not improve rates of catheter clearance but do increase the risk of adverse effects, such as hemorrhage (Table 2). 44 …”

Section: Recombinant Urokinasementioning

confidence: 99%

“…After only 30-40 min, catheter clearance rates for reteplase were 67-74% in comparison to the average rates for alteplase (52%), recombinant urokinase (60%) and tenecteplase (52%) (Figure 2). 29,30,35,36,[38][39][40][41][42][43][44] Reteplase also appears to be more effective with longer dwell times and multiple doses. One dose of reteplase resulted in an average catheter clearance rate of 87% with dwell times of as little as 60 min compared to 76% average clearance with alteplase after twice as long (120 min).…”

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

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Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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BackgroundLong-term central venous catheters have improved the quality of care for patients with chronic illnesses, but are complicated by obstructions which can result in delay of treatment or catheter removal. Design and MethodsThis paper reviews thrombolytic treatment for catheter obstruction. Literature from Medline searches using the terms "central venous catheter", "central venous access device" OR "central venous line" associated with the terms "obstruction", "occlusion" OR "thrombolytic" was reviewed. Efficacy of thrombolytic therapy, central venous catheter clearance rates and time to clearance were assessed. ResultsAlteplase, one of the current therapies, clears 52% of obstructed catheters within 30 min with 86% overall clearance (after 2 doses, when necessary). However, newer medications may have higher efficacy or shorter time to clearance. Reteplase cleared 67-74% within 30-40 min and 95% of catheters overall. Occlusions were resolved in 70 and 83% of patients with one and 2 doses of tenecteplase, respectively. Recombinant urokinase cleared 60% of catheters at 30 min and 73% overall. Alfimeprase demonstrated rapid catheter clearance with resolution in 40% of subjects within 5 min, 60% within 30 min, and 80% within 2 h. Additionally, urokinase prophylaxis decreased the incidence of catheter occlusions from 16-68% in the control group to 4-23% in the treatment group; in some studies, rates of catheter infections were also decreased in the urokinase group. ConclusionsThrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction.

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Section: Comparison Of Thrombolytic Medicationscontrasting

confidence: 53%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

Section: Recombinant Urokinasementioning

confidence: 99%

Section: Comparison Of Thrombolytic Medicationsmentioning

confidence: 99%

See 3 more Smart Citations

Thrombolytic therapy for central venous catheter occlusion

Baskin¹,

Reiss²,

Wilimas³

et al. 2011

Haematologica

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Interventions for restoring patency of occluded central venous catheter lumens

Miert

Hill

Jones

2012

Cochrane Database of Systematic Reviews

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There is inadequate evidence to draw strong conclusions on the efficacy or safety of the drug interventions included in this review. There is some low quality evidence from a meta-analysis of two studies investigating urokinase (various strengths) and some very low evidence from two single studies investigating alteplase 2 mg/2 mL that suggest that these two drug interventions may be effective in treating withdrawal or total occlusion of CVC lumens caused by thrombosis. Further high quality, sufficiently powered research is still required to look at the efficacy and safety of urokinase, alteplase and other chemical, surgical and drug interventions for treating CVC lumen occlusion. Research studies which exclusively include child participants are especially warranted.

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Interventions for restoring patency of occluded central venous catheter lumens (Review)

Miert

Hill

Jones

2013

Evid.‐Based Child Health

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Background Central venous catheters (CVCs) facilitate the administration of intravenous drugs, fluids, blood products and parenteral nutrition to patients with either chronic disease or critical illness. Despite a pivotal role within medical management, a common complication associated with CVC use is occlusion of the CVC lumen(s). CVC occlusion can interrupt and cause serious delays in administration of treatment interventions. Objectives The primary objective of this review was to assess the efficacy and safety of different interventions used to restore patency of occluded CVC lumens, in adults and children. Search methods We identified trials by searching the Cochrane Central Register of Clinical Trials (CENTRAL) (The Cochrane Library 2011, Issue 9); OvidSP MEDLINE (1950 to September 2011); OvidSP EMBASE (1980 to September 2011) and NHS Evidence CINAHL (1982 to September 2011). We also searched clinical trial registers, handsearched reference lists, contacted pharmaceutical companies and authors of publications that met the inclusion criteria to identify trials. Selection criteria We selected randomized controlled trials which investigated the efficacy of an intervention (chemical, surgical or drug) used to restore patency to an occluded CVC lumen, in either adults or children. Data collection and analysis Three authors independently assessed those studies that met the inclusion criteria for quality and extracted the relevant data using a standardized form. Main results No studies were found that investigated the efficacy and safety of either chemical or surgical interventions. Seven studies (eight papers) with a total of 632 participants were identified from the search. They investigated different comparisons, strengths of thrombolytic or anticoagulant drug interventions for treating CVC lumen occlusion thought to be caused by a thrombus. There was low quality evidence from a meta‐analysis of two studies suggesting that urokinase (various strengths) was more effective than placebo for restoring patency to occluded CVC lumens in adults and children with underlying medical conditions (relative risk (RR) 2.09, 95% confidence interval (CI) 1.47 to 2.95), with a number needed to treat of 4 (95% CI 2 to 8). There was insufficient evidence to draw conclusions on the safety of urokinase. The overall quality of the evidence provided by these studies was low to very low due to one or more domains being assessed as either at 'unclear risk of bias' or 'high risk of bias'. Furthermore, the total number of participants in these studies was small and consequently may lead to spurious results. Authors' conclusions There is inadequate evidence to draw strong conclusions on the efficacy or safety of the drug interventions included in this review. There is some low quality evidence from a meta‐analysis of two studies investigating urokinase (various strengths) and some very low evidence from two single studies investigating alteplase 2 mg/2 mL that suggest that these two drug interventions may be effective in treating ...

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Recombinant urokinase is safe and effective in restoring patency to occluded central venous access devices: A multiple-center, international trial*?

Abstract: The use of a new r-UK, 5000 IU/mL, is safe and effective for the restoration of patency to occluded CVADs.

Cited by 49 publications

References 13 publications

Thrombolytic therapy for central venous catheter occlusion

Thrombolytic therapy for central venous catheter occlusion

Interventions for restoring patency of occluded central venous catheter lumens

Interventions for restoring patency of occluded central venous catheter lumens (Review)

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