Abstract
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.
Keywords
Anticoagulants - catheter - dialysis - hemodialysis - heparin - prophylaxis - tissue
plasminogen activator
