The efficacy of reteplase in the treatment of thrombosed hemodialysis venous catheters

Abstract

Hemodialysis patients frequently require temporary venous catheters until suitable arteriovenous (AV) access can be placed and used for cannulation. However, these temporary catheters often occlude before the AV access has matured. The National Kidney Foundation (NKF) recommends using urokinase to clear the thrombus before progressing to the more invasive and costly procedure of catheter replacement, but urokinase is not currently available. The recombinant tissue-plasminogen activator, reteplase (Retavase, Centocor, Inc., Malvern, PA) was used to clear catheters in 62 patients (a total of 199 doses) at two for-profit outpatient hemodialysis centers with an overall success rate of 91.4% and a minimal cost of $44 per dose. Reteplase was found to be an efficacious and cost-effective alternative to urokinase in the treatment of occluded dialysis venous catheters.