The Evaluation of short-term and long-term effects of fibrinolytic drug Alteplase on catheters dysfunction in dialysis patients Effects of Alteplase on catheters dysfunction
School of Medicine Students' Journal,
Vol. 4 (2022),
28 November 2023
Introduction: Despite the tendency to important infectious and mechanical complications, central venous catheters have become a common means of vascular access worldwide for patients requiring hemodialysis. In some studies, the use of fibrinolytic drugs is effective in the treatment of catheter function problems. In this study, the effects of Alteplase (a fibrinolytic drug) on catheter function was investigated.
Methods: This study was performed on 100 dialysis patients in the dialysis ward of Imam Reza Hospital in Kermanshah (Iran) who had a catheter dysfunction. After confirmation by the nephrologist, in case of catheter dysfunction and failure to resolve it with the usual methods, one milligram of Alteplase with normal saline was added to each lumen of the catheter and left in place for one hour. After aspirating the lacquered solution, the rate of blood outflow was assessed by aspiration, and catheter function was evaluated.
Results: The mean age was 60.31 +- 11.67 years. 52 patients were male and 48 patients were female. In terms of catheter implantation time, 20 patients were less than 3 months, 12 patients were between 3 to 6 months and 68 patients were more than 6 months. The duration of proper catheter function after injection was less than 3 months in 11 patients, between 3 to 6 months in 31 patients, and more than 6 months in 58 patients. Only 6 out of 100 cases received 2 mg and others received 1 mg of the drug. 25 patients had the insufficient effect of the drug on catheter function in terms of blood flow velocity, and in 75 patients this effect was good. Only 8 patients had inoperable lock catheters. Out of 100 patients studied, 7 had temporary catheters and 93 had permanent catheters.
Conclusion: Alteplase is safe and effective on catheter function in hemodialysis patients.
- Hemodialysis, Alteplase, Blood flow velocity, Fibrinolytic drug
How to Cite
2. Hakim R, Depner T, Parker III T. Adequacy of hemodialysis. Am J Kidney Dis. 1992;20(2):107-23.
3. Rehman R, Schmidt RJ, Moss AH. Ethical and legal obligation to avoid long-term tunneled catheter access. Clin J Am Soc Nephrol. 2009;4(2):456-60
4. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis. 2005;46(3):501-8.
5. Wong J, Sadler D, McCarthy M, Saliken J, So C, Gray R. Analysis of early failure of tunneled hemodialysis catheters. Am J Roentgenol. 2002;179(2):357-63.
6. Weiss MF, Scivittaro V, Anderson JM. Oxidative stress and increased expression of growth factors in lesions of failed hemodialysis access. Am J Kidney Dis. 2001;37(5):970-80.
7. Hoshal VL, Ause RG, Hoskins PA. Fibrin sleeve formation on indwelling subclavian central venous catheters. Arch Surg. 1971;102(4):353-8.
8. Forauer AR, Theoharis CG, Dasika NL. Jugular vein catheter placement: histologic features and development of catheter-related (fibrin) sheaths in a swine model. Radiology. 2006;240(2):427-34.
9. De Vos JY. Anticoagulation therapy in acute renal failure extracorporeal treated patients. EDTNA‐ERCA Journal. 2002;28(S2):30-3.
10. Kh A, Cheraghi M. Comparison of two methods of priming hemodialysis set by normal saline & heparinated normal saline on clot formation in hemodialysis. J Shahid Sadoughi Univ Med Sci. 2002;10(3 Suppl):10-6.
11. Hojjat M. Dialysis efficacy in patients with ESRD. Magazine of Critical Care Nursing Summer 2009;2(2):61-66.
12. Tayebi A. Intensive care in dialysis. 1th ed. Tehran: Teimourzadeh; 2008.p. 103-27.
13. Vascular A. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006;48:S176.
14. Moran JE, Ash SR, Committee CP, editors. Locking solutions for hemodialysis catheters; heparin and citrate—a position paper by ASDIN. Seminars in dialysis; 2008: Wiley Online Library.
15. Brügemann J, van der Meer J, Born VJ, van der Schaaf W, de Graeff PA, Lie KI. Anti-streptokinase antibodies inhibit fibrinolytic effects of anistreplase in acute myocardial infarction. Amer J Cardiol.1993;72 (5):462-4
16. Schenk P, Rosenkranz AR, Wölfl G, Hörl WH, Traindl O. Recombinant tissue plasminogen activator is a useful alternative to heparin in priming quinton permcath. Am J Kidney Dis. 2000;35(1):130-6.
17. Mozafar M, Alborzi M, Moradi A. Effects of Clopidogrel on Longevity of Permanent Double-Lumen Catheter Patency in Dialysis Patients: A Single-Blind Placebo-Controlled Clinical Trial. NU monthly. 2018; 10(2)
18. Mendes ML, Castro JH, Silva TN, Barretti P, Ponce D. Effective use of alteplase for occluded tunneled venous catheter in hemodialysis patients. Artif Organs. 2014;38(5):399-403.
19. Yaseen O, El‐Masri MM, El Nekidy WS, Soong D, Ibrahim M, Speirs JW, et al. Comparison of alteplase (tissue plasminogen activator) high‐dose vs. low‐dose protocol in restoring hemodialysis catheter function: The ALTE‐DOSE study. Hemodial Int. 2013;17(3):434-40.
20. Baskin JL, Reiss U, Wilimas JA, Metzger ML, Ribeiro RC, Pui C-H, et al. Thrombolytic therapy for central venous catheter occlusion. Haematologica. 2012;97(5):641.
21. Tumlin J, Goldman J, Spiegel DM, Roer D, Ntoso KA, Blaney M, et al. A phase III, randomized, double-blind, placebo-controlled study of tenecteplase for improvement of hemodialysis catheter function: TROPICS 3. Clin J Am Soc Nephrol. 2010;5(4):631-6.
22. R Vanholder, N Hoenich, S Ringoir. Morbidity and mortality of central venous catheter hemodialysis: A review of 10 years' experience. Nephron. 1987;47:274-279.
23. SJ Schwab, GL Buller, RL McCann, RR Bollinger, DL Stickel. Prospective evaluation of a Dacron cuffed hemodialysis catheter for prolonged use. Am J Kidney Dis. 1988;11:166-169.
24. ZJ Twardowski. High-dose intradialytic urokinase to restore the patency of permanent central vein hemodialysis catheters. Am J Kidney Dis. 1998;31:841-847.
25. Hilleman D, Campbell J. Efficacy, safety, and cost of thrombolytic agents for the management of dysfunctional hemodialysis catheters: a systematic review. Pharmacotherapy. 2011;31:1031–1040.
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