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ORIGINAL ARTICLE
Year : 2011  |  Volume : 1  |  Issue : 2  |  Page : 29-34

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


1 Department of Medicine, University of Damascus, Damascus, Syria
2 Department of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
3 Department of Medicine, The University of Texas Health Science at Houston, Houston, Texas, USA
4 Division of Nephrology, Elmhurst Hospital Center, New York, USA
5 Cardiovascular Institute, Mount Sinai Medical Center, New York, USA

Correspondence Address:
Umesh Gidwani
Mount Sinai Medical Center, Director of Cardiac Critical Care, Cardiovascular Institute (Box 1030), One Gustave L. Levy Place, New York, NY 10029
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0770.90913

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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.


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