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Alteplase for the treatment of catheter occlusion in pediatric patients

Debra M Anderson1, Kimberly A Pesaturo, Jonathan Casavant

  • 1Department of Pharmacy, Harrington Memorial Hospital, Southbridge, MA, USA. danderso@harringtonhospital.org

The Annals of Pharmacotherapy
|March 7, 2013
PubMed

Insights

Alteplase effectively restores patency in pediatric central venous catheters occluded by thrombi. While efficacy is promising for venous catheters, more data is needed for dialysis catheter occlusions in children.

Area of Science:

  • Pediatric critical care medicine
  • Pharmacology
  • Vascular access

Background:

  • Catheter occlusion is a common complication in pediatric patients requiring venous or dialysis access.
  • Thrombus formation is a primary cause of catheter occlusion, necessitating effective treatment strategies.
  • Alteplase (tissue plasminogen activator) is a fibrinolytic agent used for thrombolysis.

Purpose of the Study:

  • To review existing literature on the efficacy of alteplase in restoring patency of occluded venous and dialysis catheters in pediatric patients.
  • To synthesize available data on alteplase dosing, dwell times, and success rates in pediatric populations.
  • To identify limitations in current research and areas for future investigation.

Main Methods:

  • A comprehensive literature search was conducted using MEDLINE and EMBASE databases up to November 2012.
  • Search terms included "alteplase," "tissue plasminogen activator," and "catheter."
  • Studies were limited to human subjects, English language, and pediatric age range (neonates to 18 years), excluding case reports, reviews, and studies with specific patient populations (hemophilia, high malignancy rates).

Main Results:

  • Alteplase is a recommended fibrinolytic for restoring patency of thrombus-occluded catheters.
  • Studies indicate overall efficacy of alteplase for central venous catheter (CVC) occlusion in children ranges from 50% to 90%, with higher doses and longer dwell times showing greater success.
  • For occluded peritoneal or hemodialysis catheters, alteplase demonstrated efficacy in 57-100% of cases with specific dosing and dwell times.

Conclusions:

  • Alteplase demonstrates efficacy in treating thrombus-related venous catheter occlusions in pediatric patients.
  • Limited data currently exists regarding the effectiveness of alteplase for occluded dialysis catheters in this age group.
  • Further pediatric-specific prospective trials are needed to fully establish the role of alteplase in catheter occlusion management.
Abstract

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