McGill Rita L, Spero Joel A, Sysak Joshua C, Sandroni Stephen E, Marcus Richard J
Division of Nephrology and Hypertension, West Penn Allegheny Health System, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Hemodial Int. 2008 Jul;12(3):348-51. doi: 10.1111/j.1542-4758.2008.00280.x.
Tunneled hemodialysis catheters require a "locking solution" between treatments to prevent catheter thrombosis. Heparin locks can be unsafe in patients with life-threatening bleeding diathesis because of unintentional anticoagulation. This study was designed to define the hematologic consequences of using tissue plasminogen activator (t-PA) as an alternative locking solution after heparin-free hemodialysis (HF-HD). Following HF-HD, t-PA 2 mg was instilled into each lumen of the dialysis catheter in 10 patients. Euglobulin clot lysis time (ECLT), fibrinogen, D-dimer, and fibrin degradation products were measured during the last hour of dialysis, and repeated 15 and 30 minutes after catheter locking. Dialysis catheter performance was reassessed at the time of the next hemodialysis. Fibrinogen, D-dimer, and fibrin degradation products were elevated at all time points, but did not change after t-PA. ECLT decreased significantly from baseline 15 minutes after catheter locking (217+/-64 vs. 132+/-75 min, p=0.016). ECLT values had returned to baseline (202+/-56 minutes) by 30 minutes. No episodes of bleeding or catheter thrombosis occurred, and catheter performance did not deteriorate. A 2 mg t-PA locking solution preserved dialysis catheter performance. ECLT decreased at 15 minutes, but normalized by 30 minutes, and did not enter the range in which bleeding would be likely. No clinical events were seen during this transient increase in systemic fibrinolysis.
隧道式血液透析导管在两次治疗之间需要一种“封管溶液”以防止导管血栓形成。由于存在意外抗凝作用，肝素封管对有危及生命的出血素质的患者可能不安全。本研究旨在确定在无肝素血液透析（HF-HD）后使用组织型纤溶酶原激活剂（t-PA）作为替代封管溶液的血液学后果。在HF-HD后，向10例患者透析导管的每个管腔内注入2 mg t-PA。在透析的最后一小时测量优球蛋白凝块溶解时间（ECLT）、纤维蛋白原、D-二聚体和纤维蛋白降解产物，并在导管封管后15分钟和30分钟重复测量。在下一次血液透析时重新评估透析导管的性能。纤维蛋白原、D-二聚体和纤维蛋白降解产物在所有时间点均升高，但在注入t-PA后没有变化。导管封管后15分钟，ECLT较基线显著缩短（217±64 vs. 132±75分钟，p = 0.016）。到30分钟时，ECLT值已恢复至基线水平（202±56分钟）。未发生出血或导管血栓形成事件，且导管性能未恶化。2 mg t-PA封管溶液可维持透析导管性能。ECLT在15分钟时缩短，但在30分钟时恢复正常，且未进入可能发生出血的范围。在全身纤溶短暂增加期间未观察到临床事件。
