阿替普酶与尿激酶用于治疗闭塞性血液透析导管

Alteplase versus urokinase for occluded hemodialysis catheters.

作者信息

Zacharias James M, Weatherston Christine P, Spewak Candace R, Vercaigne Lavern M

机构信息

Department of Internal Medicine, Section of Nephrology, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

Ann Pharmacother. 2003 Jan;37(1):27-33. doi: 10.1345/aph.1C105.

DOI:10.1345/aph.1C105

PMID:12503929

Abstract

BACKGROUND

The use of central venous catheters as a source of vascular access in patients undergoing hemodialysis may be complicated by thrombosis. Frequently, thrombolytics are used in an attempt to reestablish blood flow through partially or completely occluded catheters.

OBJECTIVE

To compare the efficacy of alteplase (recombinant tissue plasminogen activator) versus urokinase in reestablishing adequate blood flow through partially or completely occluded vascular catheters.

METHODS

Part 1 of the study prospectively investigated the effect of alteplase in reestablishing adequate blood flow through partially or completely occluded vascular catheters in 30 hemodialysis patients. Part 2 of the trial compared the efficacy of alteplase with that of urokinase in 14 of 30 patients who had also previously received urokinase. A 30-minute push-protocol was used to administer thrombolytics in both parts of the study. The primary endpoint was the proportion of patients with partially or completely occluded catheters achieving post-thrombolytic blood flow of > or =200 mL/min.

RESULTS

Part 1 showed a large proportion of partially or completely occluded catheters achieving post-alteplase blood flows > or =200 mL/min (70/76, 92.1% vs. 34/40, 85%, respectively). In Part 2 of the study, the proportion of partially occluded catheters achieving post-thrombolytic blood flows > or =200 mL/min was not significantly different between the alteplase and urokinase groups, (36/41, 87.8% vs. 21/28, 75%, respectively; p = 0.205). The proportion of completely occluded catheters achieving post-thrombolytic blood flows > or =200 mL/min was significantly better with alteplase compared with urokinase (15/17, 88.2% vs. 6/14, 42.8%, respectively; p =.018).

CONCLUSIONS

Alteplase, administered via the 30-minute push-protocol, is an effective thrombolytic for restoring hemodialysis catheter patency. In our study sample, alteplase was generally more effective than urokinase in restoring blood flow through catheters, especially those that were completely occluded.

摘要

背景

在接受血液透析的患者中，使用中心静脉导管作为血管通路可能会并发血栓形成。通常，会使用溶栓剂来试图恢复通过部分或完全堵塞导管的血流。

目的

比较阿替普酶（重组组织型纤溶酶原激活剂）与尿激酶在恢复通过部分或完全堵塞的血管导管的充足血流方面的疗效。

方法

研究的第1部分前瞻性地调查了阿替普酶对30例血液透析患者恢复通过部分或完全堵塞的血管导管的充足血流的效果。试验的第2部分在30例之前也接受过尿激酶治疗的患者中的14例中比较了阿替普酶与尿激酶的疗效。在研究的两个部分中均采用30分钟推注方案来给予溶栓剂。主要终点是部分或完全堵塞导管的患者在溶栓后血流达到≥200 mL/分钟的比例。

结果

第1部分显示，很大比例的部分或完全堵塞导管在使用阿替普酶后血流达到≥200 mL/分钟（分别为70/76，92.1% 对34/40，85%）。在研究的第2部分中，阿替普酶组和尿激酶组之间，部分堵塞导管在溶栓后血流达到≥200 mL/分钟的比例无显著差异（分别为36/41，87.8% 对21/28，75%；p = 0.205）。与尿激酶相比，阿替普酶使完全堵塞导管在溶栓后血流达到≥200 mL/分钟的比例显著更高（分别为15/17，88.2% 对6/14，42.8%；p = 0.018）。