The Efficacy and Safety of Reteplase for Thrombolysis of Hemodialysis Catheters at a Community and Academic Regional Medical Center

Abstract

In occluded hemodialysis catheters, thrombolytic agents are used to dissolve fibrin clots, reestablish blood flow and allow the patient to continue with hemodialysis treatment. Prior to 2001, urokinase was the indicated fibrinolytic for hemodialysis catheter thrombolysis. However, when urokinase became unavailable in the United States, New Hanover Regional Medical Center developed and implemented a protocol for the use of another fibrinolytic, reteplase, to lyse catheter occlusions. The purpose of this retrospective analysis was to assess the safety and efficacy of reteplase in opening occluded catheters in a series of patients receiving hemodialysis. Between January 1 and June 30, 2002, 59 patients could not complete dialysis, because of either poor arterial blood flow or elevated venous resistance. Reteplase, 0.4 U, was administered to the lumen of occluded catheters. After 30 min dwell times, the lumens were aspirated. If flow could not be sufficiently reestablished, a second reteplase dose was administered. Efficacy endpoints were defined as the ability to complete hemodialysis and achieve flow rates of ≧250 ml/min. Safety endpoints were defined as the occurrence of allergic reactions or bleeding. Eighty-five percent (50/59) of the patients were able to complete their hemodialysis session following reteplase administration, with 70% (41/59) able to sustain blood flow rates of ≧250 ml/min. Of the 50 patients who successfully completed dialysis, 66% (33/50) required only one 0.4-unit dose of reteplase per lumen while 34% (17/50) required a second dose. No instances of bleeding or allergic reactions were noted.

Recombinant tissue plasminogen activator infusion for hemodialysis catheter clearance

“…In addition, at the time of submitting the manuscript, a newer rtPA, reteplase, was introduced in an attempt to increase the rapidity of catheter thrombolysis. The few available studies demonstrated equal efficacy (of reteplase) with altepase while shorter duration of local instillation may be required for re-canalization [26,27,28].…”

Catheter Management in Hemodialysis Patients

“…Reteplase (0.4 U/lumen; dwell time, 30 minutes) restored/improved Qb in 44 of 50 patients (69); 50 of 59 patients were able to complete HD in another study (70).…”

“…Reteplase has demonstrated similar efficacy in restoring the flow of occluded HD catheters in two retrospective analyses (69,70). Reteplase (0.4 U/lumen; dwell time, 30 minutes) restored/improved Qb in 44 of 50 patients (69); 50 of 59 patients were able to complete HD in another study (70).…”

Improvement of Hemodialysis Catheter Function with Tenecteplase: A Phase III, Open-Label Study: TROPICS 4

“…Studies evaluating alteplase [12, 14, 15, 20-22, 24, 26, 28, 32], urokinase [4,6,9,10,15,23,25,27,[29][30][31], and reteplase [8,11,16,18,19] did not report AEs attributed to the drugs studied, but generally provided insufficient safety data to adequately detect infrequent yet potentially important AEs. In contrast, as the first phase III safety study of a thrombolytic for HD catheter dysfunction, TROPICS 4 had a sample size large enough to estimate incidence rates of relatively common AEs.…”