Comparison of alteplase (tissue plasminogen activator) high‐dose vs. low‐dose protocol in restoring hemodialysis catheter function: The ALTE‐DOSE study

Abstract

Hemodialysis catheter (HDC) dysfunction due to thrombosis is common, and dysfunction incidence can reach up to 50% within 1 year of use. Although administration of intraluminal alteplase (tissue plasminogen activator [tPA]) is the standard of practice to pharmacologically restore HDC function, there are no evidence-based guidelines concerning the optimal tPA dose. The purpose of this study was to compare the efficacy of 1.0-mg vs. 2.0-mg tPA dwell protocols in restoring the HDC function in thrombotic dysfunctional catheters. A retrospective, single-center study was conducted on two independent cohorts of patients; the first (n = 129) received 2.0 mg tPA/catheter lumen, while the second (n=108) received 1.0 mg tPA/catheter lumen. Kaplan-Meier and Cox regression analyses were performed to compare the catheter survival time between patients who received 1.0 mg tPA and those who received 2.0 mg tPA. Catheter removal occurred in 25 (19.4%) of those catheters treated with 1.0 mg tPA compared with 11 (10.2%) of catheters treated with 2.0 mg tPA (P = 0.05). The hazard ratio (HR) for catheter removal was 2.75 (95% confidence interval [(95%) CI] = 1.25-6.04) for the 1.0-mg tPA cohort compared with the 2.0-mg tPA cohort. Correction added on 3 December 2012, after first online publication: The tPA cohort values were changed. Female gender (HR = 2.51; (95%) CI = 1.20-5.27) and age (HR = 0.96; (95%) CI = 0.94-0.98) were also associated with catheter survival. Our findings suggest that treatment of dysfunctional HDC with 2.0-mg tPA dwells is superior to 1.0-mg tPA dwells.