Recombinant Tissue Plasminogen Activator is Safe and Effective in Increasing Haemodialysis Catheter Longevity in Paediatric Haemodialysis Patients

Abstract

Background: Haemodialysis catheter (HDC) occlusion is a common cause of poor blood flow, inadequate dialysis and HDC loss. From Jan 2009, our unit used infusions of recombinant tissue plasminogen activator (rtPA), Alteplase 0.1-0.2 mg/kg/hour over 1-2 hours for thrombolysis of occluded catheters. Methods: Retrospective review of outcomes of all patients who were treated with rtPA infusion for HDC occlusion in our unit between Jan 2009 to Dec 2012. Twenty patients underwent 5,407 sessions of catheter-directed haemodialysis in our unit (mean age 7.4 years, range 0.3-15.8 years). Results: Ten patients accounted for 339 episodes of rtPA infusions (median 12, range 1-115). Thirty-three radiographic contrast studies were performed – 21 (64%) confirmed presence of thrombus. The immediate success rate, defined as return of manual aspiration and infusion capabilities to both ports was 100%. No patients required exclusion from thrombolytic therapy due to contraindications. One patient had rtPA infusion discontinued after 9 infusions due to spontaneous bruising despite normal fibrinogen levels. The remainder of patients tolerated the treatment well. All patients had normal coagulation profile. No HDC were surgically changed due to occlusion by thrombus. Conclusion: Low dose Alteplase infusion is safe and efficacious in the management of HDC occlusion. It provides a means for improving the long-term survival of HDC catheters in patients with limited available options of vascular access for haemodialysis.