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Use of Alteplase for Clearing Peritoneal Dialysis Catheter Occlusion
1Department of Pharmacy, Augusta University Medical Center, Augusta, Georgia.
Insights
Alteplase effectively clears fibrin occlusions in peritoneal dialysis (PD) catheters, potentially reducing the need for surgical intervention. This review examines the evidence for alteplase in treating PD catheter dysfunction.
Area of Science:
- Nephrology
- Gastroenterology
- Vascular Surgery
Background:
- Peritoneal dialysis (PD) catheter complications lead to 20% of PD to hemodialysis transfers.
- Outflow obstruction from fibrin deposits is a common PD catheter complication.
- Alteplase is used for refractory fibrin occlusions, but evidence is limited.
Purpose of the Study:
- To review the existing literature on alteplase use for fibrin-induced PD catheter occlusion.
- To assess the efficacy and safety of alteplase in managing PD catheter dysfunction.
Main Methods:
- A comprehensive literature search was performed using MEDLINE and citation tracking.
- Search terms included "alteplase", "peritoneal dialysis catheter", "occlusion", "fibrin", and "tissue plasminogen activator".
- Included studies comprised 1 pilot study, 3 case series, and 2 case reports.
Main Results:
- Alteplase successfully cleared PD catheter occlusions in most reported cases.
- Unsuccessful treatments often revealed surgically correctable or mechanical causes.
- Alteplase demonstrated a high success rate in resolving fibrin-related PD catheter blockages.
Conclusions:
- Alteplase is a viable alternative to surgical catheter removal for fibrin occlusions.
- It appears safe and may reduce the necessity for surgical correction.
- Further research may solidify alteplase's role in PD catheter management.
Background:
Peritoneal dialysis (PD) catheter complications account for 20% of all transfers from PD to hemodialysis. One complication is outflow obstruction caused by fibrin deposits within the lumen of the catheter. Alteplase is frequently used to clear fibrin deposits in PD catheters that are refractory to other therapies. However, the literature basis for this practice is unclear.
Method:
A review of the literature was conducted to determine the evidence existing for alteplase use in PD catheter occlusion due to fibrin. A literature search of MEDLINE (1967-present) was conducted using the search terms "alteplase", "peritoneal dialysis catheter", "occlusion", "fibrin", and "tissue plasminogen activator". Referenced citations were also searched for pertinent material. All data concerning the use of alteplase for peritoneal dialysis catheter occlusion were included in this review. The search resulted in 1 open-label pilot study, 3 case series, and 2 case reports of alteplase use in declotting occluded PD catheters.
Results:
Based on the data, alteplase therapy cleared the occlusion of PD catheters in the majority of cases. In those that were unsuccessful, other surgically correctable and mechanical causes were identified in most cases.
Conclusion:
Alteplase appears to be an intriguing alternative to the surgical removal of the PD catheter in patients with catheter occlusion due to fibrin. Although not inexpensive, it appears safe and may decrease the need for surgical correction of occluded catheters.
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