To compare the efficacy of alteplase with that of urokinase (UK) in restoring the patency of occluded central venous catheters in children.
Study Design:
Retrospective case–control study at Hôpital Ste-Justine, a pediatric teaching hospital.
Results:
87 UK and 46 alteplase prescriptions were studied. Alteplase was effective in 93.2% of cases of occluded central venous catheters and UK in 54.5% of cases (p < 0.001).
Conclusions:
Alteplase was clearly superior to UK for restoring the patency of occluded central venous catheters in children. The study is limited by its retrospective design.
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References
1.
SuhockiPVConlonPJJrKnelsonMHHarlandRSchwabSJ. Silastic cuffed catheters for hemodialysis vascular access: Thrombolytic and mechanical correction of malfunction. Am J Kidney Dis1996; 28: 379–86.
2.
HurtubiseMRBottinoJCLawsonMMcCredieKB. Restoring patency of occluded central venous catheters. Arch Surg1980; 115: 212–3.
3.
AndrewMMichelsonADBovillELeakerMMassicotteMP. Guidelines for antithrombotic therapy in pediatric patients. J Pediatr1998; 132: 575–88.
4.
Food and Drug Administration. Center for Biologics Evaluation and Research. Department of Health and Human Services. Warning letter. Update Abbokinase (urokinase). March 16, 1999.
5.
WeitzJIStewartRJFredenburghJC. Mechanism of action of plasminogen activators. Thromb Haemost1999; 82: 974–82.
6.
AtkinsonJBBagnallHAGompertsE.Investigational use of tissue plasminogen activator (t-PA) for occluded central venous catheters. J Parenteral Enteral Nutr1990; 14: 310–1.
7.
PaulsenDReisaetherAAasenMFauchaldP.Use of tissue plasminogen activator for reopening of clotted dialysis catheters. Nephron1993; 64: 468–70.
8.
HaireWDAtkinsonJBStephensLCKotulakGD. Urokinase versus recombinant plasminogen activator in thrombosed central venous catheters: A double-blinded, randomized trial. Thrombos Haemostas1994; 72: 543–7.
9.
KletaRSchleefJJürgensH.Tissue plasminogen activator and obstructed central venous catheters (letter). Med Pediatr Oncol1998; 30: 376.
10.
Canadian Pharmacists Association. Compendium des produits et specialites pharmaceutiques. 36th ed. Ottowa, Ontario, 2001.
11.
WardCWeckS.Dilution and storage of recombinant tissue plasminogen activator (Activase) in balanced salt solutions. Am J Ophthalmol1990; 109: 98–9.
12.
JaffeGJGreenGDJAbramsGW. Stability of recombinant tissue plasminogen activator. Am J Ophthalmol1989; 108: 90–1.
13.
BreslowNEDayNE. Statistical methods in cancer research. Volume 1: the analysis of case–control studies. Lyon, France: International Agency for Research on Cancer, 1980.
14.
GlynnMFXPhilDPathMRCLangerBJeejeebhoyKN. Therapy for thrombotic occlusion of long-term intravenous alimentation catheters. J Parenteral Enteral Nutr1980; 4: 387–90.
15.
LawsonMBottinoJCHurtubiseMRMcCredieKB. The use of urokinase to restore the patency of occluded central venous catheters. Am J IV Clin Nutr1982;(Oct):29–32.
16.
WinthropALWessonDE. Urokinase in the treatment of occluded central venous catheters in children. J Pediatr Surg1984; 19: 536–8.
17.
WachsT.Urokinase administration in pediatric patients with occluded central venous catheters. J IV Nurs1990; 13: 100–2.
18.
GaleGBO'ConnorDMChuJYStanleyD.Restoring patency of thrombosed catheters with cryopreserved urokinase. J Parenteral Enteral Nutr1984; 8: 298–9.
19.
SchneiderTCKrzywdaEAndrisDQuebbemanEJ. The malfunctioning silastic catheter — Radiologic assessment and treatment. J Parenteral Enteral Nutr1986; 10: 70–3.
20.
KellamBFrazeDKanarekKS. Clot lysis for thrombosed central venous catheters in pediatric patients. J Perinatol1987; 7: 242–4.
21.
NorthseaC.Using urokinase to restore patency in double lumen catheters. ANNA J1994; 21: 261–73.
22.
RubieHJuricicMClaeyssensSKrimouALemozyJIzardP, Morbidity using subcutaneous ports and efficacy of vancomycin flushing in cancer. Arch Dis Child1995; 72: 325–9.
23.
MonturoCADickersonRNMullenJL. Efficacy of thrombolytic therapy for occlusion of long-term catheters. J Parenteral Enteral Nutr1990; 14: 312–4.
