tPA in HD catheter

Q: Once-weekly instillation of tissue plasminogen activator (tPA, alteplase) in hemodialysis catheter? (select one)

A) lowers catheter malfunction 

B) lowers catheter-related bacteremia 

C) Both A and B

Answer: C

At least one small trial of 225 hemodialysis-dependent patients from Calgary, Canada, showed that once-weekly instillation of tissue plasminogen activator (tPA or alteplase) - 1 mg in each lumen - not only lowers the catheter malfunction (20 vs. 35 percent) but also catheter-related bacteremia (4.5 vs. 13 percent). The reduction in bacteremia is probably due to less thrombosis-led infection. Said that practice is not widely used.

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Reference:

Hemmelgarn BR, Moist LM, Lok CE, et al. Prevention of dialysis catheter malfunction with recombinant tissue plasminogen activator. N Engl J Med 2011; 364:303.