Download PDF
CC BY-NC-ND 4.0 · Avicenna J Med 2011; 01(02): 29-34
DOI: 10.4103/2231-0770.90913
ORIGINAL ARTICLE

Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review

Belal M Firwana
Department of Medicine, University of Damascus, Damascus, Syria
,
Rim Hasan
Department of Medicine, University of Damascus, Damascus, Syria
,
Mazen Ferwana
Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
,
Joseph Varon
Department of Medicine, The University of Texas Health Science at Houston, Houston, Texas, USA
,
Aaron Stern
Division of Nephrology, Elmhurst Hospital Center, New York, USA
,
Umesh Gidwani
Cardiovascular Institute, Mount Sinai Medical Center, New York, USA
› Author Affiliations Source of Support Nil.
› Further Information
  PDF Download Permissions and Reprints

Abstract

Background and Objectives: Hemodialysis catheters are commonly used when renal replacement therapy is initiated. These catheters have significant complications. Among "locking" solutions used in an attempt to decrease these complications is recombinant tissue plasminogen activator (rt-PA). This systematic review is to determine the efficacy of rt-PA versus heparin, the standard of care. Materials and Methods: A systematic review of randomized controlled trials studying rt-PA alone or rt-PA plus heparin versus heparin alone as locking agents for hemodialysis catheters, which included patients needed a temporary hemodialysis catheter for hemodialysis. We identified relevant trials through electronic databases and correspondence with experts. Two investigators independently reviewed potentially eligible trials and extracted data. Results: Three trials met the inclusion criteria. One trial reported an improved catheter malfunctioning in patients using rt-PA plus heparin to lock catheters (20.0%) versus heparin alone (34.8%). Another trial reported higher blood flow rate in hemodialysis catheters in patients who received rt-PA (231.6 ± 12.4 mL/min) compared with those who received heparin (206.9 mL/min). The third trial reported formation and weight of clots which were decreased by half in rt-PA group versus heparin group. Conclusions: In the few randomized trials that met our inclusion criteria, the use of rt-PA as a locking solution for hemodialysis catheters seems to be associated with fewer adverse events and catheter malfunctioning as compared with heparin. Our systematic review is limited by the few randomized trials addressing our question and the wide variety of outcome measures. Further prospective randomized trials are needed to confirm this conclusion.

Keywords

Anticoagulants - catheter - dialysis - hemodialysis - heparin - prophylaxis - tissue plasminogen activator


Publication History

Article published online:
09 August 2021

© 2011. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Collins AJ, Foley RN, Gilbertson DT, Chen SC. The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol 2009;4 Suppl 1:S5-11.
  • 2 Allon M. Dialysis catheter-related bacteremia: Treatment and prophylaxis. Am J Kidney Dis 2004;44:779-91.
  • 3 Duncan ND, Singh S, Cairns TD, Clark M, El-Tayar A, Griffith M, et al. Tesio-Caths provide effective and safe long-term vascular access. Nephrol Dial Transplant 2004;19:2816-22.
  • 4 Suhocki PV, Conlon PJ Jr, Knelson MH, Harland R, Schwab SJ. Silastic cuffed catheters for hemodialysis vascular access: Thrombolytic and mechanical correction of malfunction. Am J Kidney Dis 1996;28:379-86.
  • 5 Klouche K, Amigues L, Deleuze S, Beraud JJ, Canaud B. Complications, effects on dialysis dose, and survival of tunneled femoral dialysis catheters in acute renal failure. Am J Kidney Dis 2007;49:99-108.
  • 6 Ishani A, Collins AJ, Herzog CA, Foley RN. Septicemia, access and cardiovascular disease in dialysis patients: The USRDS Wave 2 study. Kidney Int 2005;68:311-8.
  • 7 Oliver MJ, Callery SM, Thorpe KE, Schwab SJ, Churchill DN. Risk of bacteremia from temporary hemodialysis catheters by site of insertion and duration of use: A prospective study. Kidney Int 2000;58:2543-5.
  • 8 Schillinger F, Schillinger D, Montagnac R, Milcent T. Post catheterisation vein stenosis in haemodialysis: Comparative angiographic study of 50 subclavian and 50 internal jugular accesses. Nephrol Dial Transplant 1991;6:722-4.
  • 9 Daeihagh P, Jordan J, Chen J, Rocco M. Efficacy of tissue plasminogen activator administration on patency of hemodialysis access catheters. Am J Kidney Dis 2000;36:75-9.
  • 10 Mojibian H, Spector M, Ni N, Eliseo D, Pollak J, Tal M. Initial clinical experience with a new heparin-coated chronic hemodialysis catheter. Hemodial Int 2009;13:329-34.
  • 11 Willms L, Vercaigne LM. Does warfarin safely prevent clotting of hemodialysis catheters? A review of efficacy and safety. Semin Dial 2008;21:71-7.
  • 12 Pierce DA, Rocco MV. Trisodium citrate: An alternative to unfractionated heparin for hemodialysis catheter dwells. Pharmacotherapy 2010;30:1150-8.
  • 13 Power A, Duncan N, Singh SK, Brown W, Dalby E, Edwards C, et al. Sodium citrate versus heparin catheter locks for cuffed central venous catheters: A single-center randomized controlled trial. Am J Kidney Dis 2009;53:1034-41.
  • 14 Malo J, Jolicoeur C, Theriault F, Lachaine J, Senecal L. Comparison between standard heparin and tinzaparin for haemodialysis catheter lock. ASAIO J 2010;56:42-7.
  • 15 Chesler L, Feusner JH. Use of tissue plasminogen activator (rrt-PA) in young children with cancer and dysfunctional central venous catheters. J Pediatr Hematol Oncol 2002;24:653-6.
  • 16 Blaney M, Shen V, Kerner JA, Jacobs BR, Gray S, Armfield J, et al. CAPS Investigators. Alteplase for the treatment of central venous catheter occlusion in children: Results of a prospective, open-label, single-arm study (The Cathflo Activase Pediatric Study). J Vasc Interv Radiol 2006;17:1745-51.
  • 17 Schenk P, Rosenkranz AR, Wolfl G, Horl WH, Traindl O. Recombinant tissue plasminogen activator is a useful alternative to heparin in priming quinton permcath. Am J Kidney Dis 2000;35:130-6.
  • 18 Hemmelgarn BR, Moist LM, Lok CE, Tonelli M, Manns BJ, Holden RM, et al. Prevention of Dialysis Catheter Lumen Occlusion with rt-PA versus Heparin Study Group. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med 2011;364:303-12.
  • 19 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;5:631-6.
  • 20 Gluud LL. Bias in clinical intervention research. Am J Epidemiol 2006;163:493-501.
  • 21 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol 2009;62:e1-34.
  • 22 Gittins NS, Hunter-Blair YL, Matthews JN, Coulthard MG. Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: A randomised controlled trial. Arch Dis Child 2007;92:499-501.
  • 23 Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48 Suppl 1:S248-73.
  • 24 Pettigrew M, Soltys GI, Bell RZ, Daniel N, Davis JR, Senecal L, et al. Tinzaparin reduces health care resource use for anticoagulation in hemodialysis. Hemodial Int 2011;15:273-9.
  • 25 Ouseph R, Ward RA. Anticoagulation for intermittent hemodialysis. Semin Dial 2000;13:181-7.
  • 26 Davenport A. Review article: Low-molecular-weight heparin as an alternative anticoagulant to unfractionated heparin for routine outpatient haemodialysis treatments. Nephrology (Carlton) 2009;14:455-61.
  • 27 Suranyi M, Chow JS. Review: Anticoagulation for haemodialysis. Nephrology (Carlton) 2010;15:386-92.
  • 28 Jonker MA, Osterby KR, Vermeulen LC, Kleppin SM, Kudsk KA. Does low-dose heparin maintain central venous access device patency?: A comparison of heparin versus saline during a period of heparin shortage. JPEN J Parenter Enteral Nutr 2010;34:444-9.
  • 29 Del Cotillo M, Grane N, Llavore M, Quintana S. Heparinized solution vs. saline solution in the maintenance of arterial catheters: A double blind randomized clinical trial. Intensive Care Med 2008;34:339-43.
  • 30 Mok E, Kwong TK, Chan MF. A randomized controlled trial for maintaining peripheral intravenous lock in children. Int J Nurs Pract 2007;13:33-45.