A Randomized Trial Comparing Two Modalities of Alteplase (tPA) Administration on Hemodialysis Catheter Patency

Objectives

To compare two alteplase (tPA) dwell protocols for clearance of occluded hemodialysis catheters. Although clinical studies support thrombolytics use in catheter clearance, optimal dwell times are not known.

Setting

A 400-bed Canadian teaching hospital.

Design

From October 2001 to May 2002, patients receiving hemodialysis via cuffed or temporary catheter with an episode of catheter dysfunction were randomized to either a short tPA dwell of 1 hour or a long tPA dwell of 48-72h. Restoration of catheter patency (defined as a BPS>250mL/min) at the next dialysis run was the primary outcome. Secondary outcomes included catheter patency two weeks post-tPA, and median catheter function post-tPA.

Results

Of the 60 enrolled patients, 28 were randomized to the 1-hour dwell and 32 to the 48-72 hour dwell. 20 (76.9%) in the short versus 27 (79.4%) in the long dwell met the primary outcome; results were not statistically significant (p=0.817). At two weeks, the number of functional catheters declined to 11 (42.3%) in the 1-hour dwell and 18 (52.4%) in the 48-72 hour dwell (p=0.414). Median catheter patency post-tPA was approximately two weeks.

Conclusions

Both tPA dwells appear equally efficacious in immediate catheter clearance with rates consistent with the literature. However, the gradual decline in functional catheters with time suggests that alternatives need to be investigated for long-term catheter management.

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