Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review

Background and Objectives: Hemodialysis catheters are commonly used when renal replacement therapy is initiated. These catheters have significant complications. Among "locking" solutions used in an attempt to decrease these complications is recombinant tissue plasminogen activator (rt-PA)....

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Autores principales:	Belal M Firwana, Rim Hasan, Mazen Ferwana, Joseph Varon, Aaron Stern, Umesh Gidwani
Formato:	article
Lenguaje:	EN
Publicado:	Thieme Medical and Scientific Publishers Pvt. Ltd. 2011
Materias:	anticoagulants catheter dialysis hemodialysis heparin prophylaxis tissue plasminogen activator Medicine R
Acceso en línea:	https://doaj.org/article/b0a9851f7a34458eadb60c944a0e6be1
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spelling	oai:doaj.org-article:b0a9851f7a34458eadb60c944a0e6be12021-12-02T17:05:51ZTissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review2231-07702249-446410.4103/2231-0770.90913https://doaj.org/article/b0a9851f7a34458eadb60c944a0e6be12011-10-01T00:00:00Zhttp://www.thieme-connect.de/DOI/DOI?10.4103/2231-0770.90913https://doaj.org/toc/2231-0770https://doaj.org/toc/2249-4464Background and Objectives: Hemodialysis catheters are commonly used when renal replacement therapy is initiated. These catheters have significant complications. Among "locking" solutions used in an attempt to decrease these complications is recombinant tissue plasminogen activator (rt-PA). This systematic review is to determine the efficacy of rt-PA versus heparin, the standard of care. Materials and Methods: A systematic review of randomized controlled trials studying rt-PA alone or rt-PA plus heparin versus heparin alone as locking agents for hemodialysis catheters, which included patients needed a temporary hemodialysis catheter for hemodialysis. We identified relevant trials through electronic databases and correspondence with experts. Two investigators independently reviewed potentially eligible trials and extracted data. Results: Three trials met the inclusion criteria. One trial reported an improved catheter malfunctioning in patients using rt-PA plus heparin to lock catheters (20.0%) versus heparin alone (34.8%). Another trial reported higher blood flow rate in hemodialysis catheters in patients who received rt-PA (231.6 ± 12.4 mL/min) compared with those who received heparin (206.9 mL/min). The third trial reported formation and weight of clots which were decreased by half in rt-PA group versus heparin group. Conclusions: In the few randomized trials that met our inclusion criteria, the use of rt-PA as a locking solution for hemodialysis catheters seems to be associated with fewer adverse events and catheter malfunctioning as compared with heparin. Our systematic review is limited by the few randomized trials addressing our question and the wide variety of outcome measures. Further prospective randomized trials are needed to confirm this conclusion.Belal M FirwanaRim HasanMazen FerwanaJoseph VaronAaron SternUmesh GidwaniThieme Medical and Scientific Publishers Pvt. Ltd.articleanticoagulantscatheterdialysishemodialysisheparinprophylaxistissue plasminogen activatorMedicineRENAvicenna Journal of Medicine, Vol 01, Iss 02, Pp 29-34 (2011)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticoagulants catheter dialysis hemodialysis heparin prophylaxis tissue plasminogen activator Medicine R
spellingShingle	anticoagulants catheter dialysis hemodialysis heparin prophylaxis tissue plasminogen activator Medicine R Belal M Firwana Rim Hasan Mazen Ferwana Joseph Varon Aaron Stern Umesh Gidwani Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
description	Background and Objectives: Hemodialysis catheters are commonly used when renal replacement therapy is initiated. These catheters have significant complications. Among "locking" solutions used in an attempt to decrease these complications is recombinant tissue plasminogen activator (rt-PA). This systematic review is to determine the efficacy of rt-PA versus heparin, the standard of care. Materials and Methods: A systematic review of randomized controlled trials studying rt-PA alone or rt-PA plus heparin versus heparin alone as locking agents for hemodialysis catheters, which included patients needed a temporary hemodialysis catheter for hemodialysis. We identified relevant trials through electronic databases and correspondence with experts. Two investigators independently reviewed potentially eligible trials and extracted data. Results: Three trials met the inclusion criteria. One trial reported an improved catheter malfunctioning in patients using rt-PA plus heparin to lock catheters (20.0%) versus heparin alone (34.8%). Another trial reported higher blood flow rate in hemodialysis catheters in patients who received rt-PA (231.6 ± 12.4 mL/min) compared with those who received heparin (206.9 mL/min). The third trial reported formation and weight of clots which were decreased by half in rt-PA group versus heparin group. Conclusions: In the few randomized trials that met our inclusion criteria, the use of rt-PA as a locking solution for hemodialysis catheters seems to be associated with fewer adverse events and catheter malfunctioning as compared with heparin. Our systematic review is limited by the few randomized trials addressing our question and the wide variety of outcome measures. Further prospective randomized trials are needed to confirm this conclusion.
format	article
author	Belal M Firwana Rim Hasan Mazen Ferwana Joseph Varon Aaron Stern Umesh Gidwani
author_facet	Belal M Firwana Rim Hasan Mazen Ferwana Joseph Varon Aaron Stern Umesh Gidwani
author_sort	Belal M Firwana
title	Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
title_short	Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
title_full	Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
title_fullStr	Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
title_full_unstemmed	Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review
title_sort	tissue plasminogen activator versus heparin for locking dialysis catheters: a systematic review
publisher	Thieme Medical and Scientific Publishers Pvt. Ltd.
publishDate	2011
url	https://doaj.org/article/b0a9851f7a34458eadb60c944a0e6be1
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_version_	1718381808930783232

Tissue plasminogen activator versus heparin for locking dialysis catheters: A systematic review

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