Hyman Gary, England Michael, Kibede Sosena, Lee Patti, Willets George
New Hanover Regional Medical Center, Wilmington, NC, USA.
Nephron Clin Pract. 2004;96(2):c39-42. doi: 10.1159/000076397.
In occluded hemodialysis catheters, thrombolytic agents are used to dissolve fibrin clots, reestablish blood flow and allow the patient to continue with hemodialysis treatment. Prior to 2001, urokinase was the indicated fibrinolytic for hemodialysis catheter thrombolysis. However, when urokinase became unavailable in the United States, New Hanover Regional Medical Center developed and implemented a protocol for the use of another fibrinolytic, reteplase, to lyse catheter occlusions. The purpose of this retrospective analysis was to assess the safety and efficacy of reteplase in opening occluded catheters in a series of patients receiving hemodialysis. Between January 1 and June 30, 2002, 59 patients could not complete dialysis, because of either poor arterial blood flow or elevated venous resistance. Reteplase, 0.4 U, was administered to the lumen of occluded catheters. After 30 min dwell times, the lumens were aspirated. If flow could not be sufficiently reestablished, a second reteplase dose was administered. Efficacy endpoints were defined as the ability to complete hemodialysis and achieve flow rates of > or =250 ml/min. Safety endpoints were defined as the occurrence of allergic reactions or bleeding. Eighty-five percent (50/59) of the patients were able to complete their hemodialysis session following reteplase administration, with 70% (41/59) able to sustain blood flow rates of > or =250 ml/min. Of the 50 patients who successfully completed dialysis, 66% (33/50) required only one 0.4-unit dose of reteplase per lumen while 34% (17/50) required a second dose. No instances of bleeding or allergic reactions were noted.
在阻塞性血液透析导管中，溶栓药物用于溶解纤维蛋白凝块，重建血流并使患者能够继续进行血液透析治疗。2001年之前，尿激酶是血液透析导管溶栓的指定纤维蛋白溶解剂。然而，当尿激酶在美国无法获得时，新汉诺威地区医疗中心制定并实施了一项使用另一种纤维蛋白溶解剂瑞替普酶来溶解导管阻塞的方案。这项回顾性分析的目的是评估瑞替普酶在一系列接受血液透析的患者中开通阻塞导管的安全性和有效性。在2002年1月1日至6月30日期间，59名患者因动脉血流不佳或静脉阻力升高而无法完成透析。将0.4单位的瑞替普酶注入阻塞导管的管腔。在停留30分钟后，抽吸管腔。如果血流未能充分重建，则给予第二剂瑞替普酶。疗效终点定义为能够完成血液透析并达到≥250毫升/分钟的流速。安全性终点定义为发生过敏反应或出血。85%（50/59）的患者在给予瑞替普酶后能够完成血液透析疗程，70%（41/59）的患者能够维持≥250毫升/分钟的血流速度。在成功完成透析的50名患者中，66%（33/50）每管腔仅需一剂0.4单位的瑞替普酶，而34%（17/50）需要第二剂。未观察到出血或过敏反应的情况。
