Techniques in dosing for thrombolysis of occluded central venous catheters.

Dosing of thrombolytic agents for restoration of flow to thrombotically occluded central venous catheters has been empiric. The lowest effective dose of any agent is not known. Given that none of the dosing regimens in current use has ever been found to be toxic, this is probably not a major clinical problem as long as the regimen is highly effective. Thrombolytic regimens differ in the type of drug, dose of drug, method of administration (injection versus prolonged infusion), and duration of administration. All of these variables are important in determining the efficacy, and possibly the toxicity, of a regimen. Active research is being conducted to determine the most effective ways of using the expanding number of thrombolytic medications that are now, or soon may be, on the market.

The efficacy of reteplase in the treatment of thrombosed hemodialysis venous catheters.

Hemodialysis patients frequently require temporary venous catheters until suitable arteriovenous (AV) access can be placed and used for cannulation. However, these temporary catheters often occlude before the AV access has matured. The National Kidney Foundation (NKF) recommends using urokinase to clear the thrombus before progressing to the more invasive and costly procedure of catheter replacement, but urokinase is not currently available. The recombinant tissue-plasminogen activator, reteplase (Retavase, Centocor, Inc., Malvern, PA) was used to clear catheters in 62 patients (a total of 199 doses) at two for-profit outpatient hemodialysis centers with an overall success rate of 91.4% and a minimal cost of $44 per dose. Reteplase was found to be an efficacious and cost-effective alternative to urokinase in the treatment of occluded dialysis venous catheters.