Department of Pharmacy, Harrington Memorial Hospital, Southbridge, MA, USA.
Ann Pharmacother. 2013 Mar;47(3):405-9. doi: 10.1345/aph.1Q483. Epub 2013 Mar 5.
To review the literature pertaining to the efficacy of alteplase for restoration of patency of occluded venous and dialysis catheters in pediatric patients.
A MEDLINE search was conducted and cross-referenced with an EMBASE search through November 2012. Search terms included alteplase, tissue plasminogen activator, and catheter.
Search results were limited to humans, English language, and ages from neonates to 18 years. Pertinent studies discussing efficacy of alteplase for restoration of occluded venous or dialysis catheter function were included. Case reports, review articles, and studies that specified inclusion of hemophilia patients or more than 75% of children with malignancy were excluded.
Fibrinolytics are the drug class of choice for restoration of patency (defined as the ability to withdraw a blood sample) of thrombus-occluded catheters. The trials used to support Food and Drug Administration approval of alteplase for central venous catheter (CVC) occlusions generally had low pediatric enrollment; however, additional small studies are available that support use of alteplase for this indication in children. Alteplase doses of 0.5-2 mg instilled into the lumen of a CVC with dwell times ranging from 30 to more than 240 minutes plus the potential for repeat dosing were reported. Overall efficacy ranged from approximately 50% to 90%, with greater efficacy generally reported with larger doses and longer dwell times. Alteplase doses of 2-2.5 mg with dwell times of 60-120 minutes were observed in 2 studies of occluded peritoneal or hemodialysis catheters, in which efficacy was reported in 57-100% of cases. Limitations of current studies of alteplase for catheter occlusion in children include small study populations and relative lack of pediatric-specific prospective trials.
Alteplase appears to show efficacy for treatment of thrombus-related venous catheter occlusion in pediatric patients; however, data regarding its use in occluded dialysis catheters are limited.
回顾关于阿替普酶治疗小儿闭塞性静脉和透析导管再通的疗效的文献。
通过 MEDLINE 搜索，并与 2012 年 11 月的 EMBASE 搜索交叉引用。搜索词包括阿替普酶、组织型纤溶酶原激活剂和导管。
搜索结果仅限于人类、英语语言和从新生儿到 18 岁的年龄。包括讨论阿替普酶治疗闭塞性静脉或透析导管功能恢复疗效的相关研究。排除了血友病患者或超过 75%的恶性肿瘤患儿的病例报告、综述文章和研究。
纤维蛋白溶解剂是血栓闭塞导管再通（定义为能够抽取血样的能力）的首选药物类别。支持阿替普酶用于中心静脉导管（CVC）闭塞的临床试验通常儿科患者人数较少；然而，还有其他一些支持阿替普酶在儿科患者中用于该适应症的小型研究。报道了将 0.5-2 毫克的阿替普酶注入 CVC 管腔，停留时间从 30 分钟到超过 240 分钟，并且可能重复给药。总体疗效从大约 50%到 90%不等，较大剂量和较长停留时间通常报告疗效较高。在 2 项闭塞性腹膜或血液透析导管的研究中观察到阿替普酶剂量为 2-2.5 毫克，停留时间为 60-120 分钟，报告的疗效在 57-100%的病例中。目前关于儿童导管闭塞的阿替普酶研究的局限性包括研究人群较小和相对缺乏儿科特定的前瞻性试验。
阿替普酶似乎对治疗小儿血栓相关性静脉导管闭塞有效；然而，关于其在闭塞性透析导管中的应用的数据有限。
