The Journal of Informed Pharmacotherapy 2004;15:410.
T Cham, B.Sc.(Pharm), JM MacRae, MD, FRCPC, S Shalansky, Pharm.D., FCSHP, G Loh,
B.Sc.(Pharm), M Kiaii, MD,
FRCPC, J Jung, B.Sc.(Pharm)
Pharmacy Department and Hemodialysis Unit, St Paul’s Hospital, Clinical Investigator Program (Kidney Foundation Fellowship) and Department of Nephrology, University of British Columbia, Vancouver, British Columbia
Canadian Society of Hospital Pharmacists (British Columbia Branch) Residency Research Presentation Night, Vancouver, British Columbia, Canada. May 2003.
Hemodialysis catheter dysfunction dysfunction due to thrombosis often requires use of a thrombolytic agent such as alteplase (rtPA) to restore patency. We prospectively evaluated a protocol using rtPA via a push method and compared it to a previous protocol using rtPA via extended dwell times.
A major Canadian adult acute care teaching hospital.
Hemodialysis patients with catheter dysfunction, as defined by a blood pump speed (BPS) </=250mL/min, received 2mg (2mL) rtPA into the catheter lumen using a 30-minute push method. Catheter patency rate (defined as an average BPS of >250mL/min) was compared to that achieved using either of two rtPA dwell protocols (1 hour or 48-72 hours) evaluated in an earlier study carried out at the same institution.
From June 1, 2002 to April 30, 2003, 45 patients had received rtPA via push method. After rtPA instillation, patency was restored to 89% in the push method arm and 78% in the extended dwell arm (p=0.16). At 2 weeks, the success rates fell to 56% in the push method arm and 52% in the extended dwell arm (p=0.69)
These results suggest a trend towards alteplase given via a push method being more effective than the dwell method for immediate restoration of catheter patency, though the difference was not statistically significant. The push method was not superior for maintaining long-term catheter patency.
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