Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial.
<h4>Background</h4>The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study.<h4>Methods</h4...
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2021
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oai:doaj.org-article:874c58bd249d4dae8b2a65bec877f3052021-11-25T06:19:04ZPrevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial.1932-620310.1371/journal.pone.0251793https://doaj.org/article/874c58bd249d4dae8b2a65bec877f3052021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251793https://doaj.org/toc/1932-6203<h4>Background</h4>The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study.<h4>Methods</h4>Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function.<h4>Results</h4>68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23-0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis.<h4>Conclusions</h4>Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis.<h4>Trial registration</h4>ClinicalTrials.gov Identifier: NCT02036255.Florence BonkainJean-Claude StolearConcetta CatalanoDominique VanderveldeSerge TreilleMarie M CouttenyeAnnemieke DhondtMark LibertalisMandelina AllamaniPhilippe MadhounAmaryllis H Van CraenenbroeckFloris VanommeslaegheFreya Van HullePhilippe DurieuxIngrid Van LimberghenChristian TielemansKarl Martin WissingPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251793 (2021) |
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Medicine R Science Q Florence Bonkain Jean-Claude Stolear Concetta Catalano Dominique Vandervelde Serge Treille Marie M Couttenye Annemieke Dhondt Mark Libertalis Mandelina Allamani Philippe Madhoun Amaryllis H Van Craenenbroeck Floris Vanommeslaeghe Freya Van Hulle Philippe Durieux Ingrid Van Limberghen Christian Tielemans Karl Martin Wissing Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. |
| description |
<h4>Background</h4>The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study.<h4>Methods</h4>Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function.<h4>Results</h4>68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23-0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis.<h4>Conclusions</h4>Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis.<h4>Trial registration</h4>ClinicalTrials.gov Identifier: NCT02036255. |
| format |
article |
| author |
Florence Bonkain Jean-Claude Stolear Concetta Catalano Dominique Vandervelde Serge Treille Marie M Couttenye Annemieke Dhondt Mark Libertalis Mandelina Allamani Philippe Madhoun Amaryllis H Van Craenenbroeck Floris Vanommeslaeghe Freya Van Hulle Philippe Durieux Ingrid Van Limberghen Christian Tielemans Karl Martin Wissing |
| author_facet |
Florence Bonkain Jean-Claude Stolear Concetta Catalano Dominique Vandervelde Serge Treille Marie M Couttenye Annemieke Dhondt Mark Libertalis Mandelina Allamani Philippe Madhoun Amaryllis H Van Craenenbroeck Floris Vanommeslaeghe Freya Van Hulle Philippe Durieux Ingrid Van Limberghen Christian Tielemans Karl Martin Wissing |
| author_sort |
Florence Bonkain |
| title |
Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. |
| title_short |
Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. |
| title_full |
Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. |
| title_fullStr |
Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. |
| title_full_unstemmed |
Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial. |
| title_sort |
prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: a randomized double-blind trial. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/874c58bd249d4dae8b2a65bec877f305 |
| work_keys_str_mv |
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