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Continuous infusion of low-dose urokinase in the treatment of central venous catheter thrombosis in infants and children.

Abstract
Thrombotic occlusion is a frequent complication associated with the use of central venous catheters. The purpose of this study was to evaluate the efficacy of a continuous infusion of low-dose urokinase (200 U/kg/h) in clearing catheters that had not cleared after two bolus doses of urokinase in a pediatric oncology population. Fifty-eight incidents of catheter-related occlusions (49 Hickman-type catheters/nine implantable ports) as documented by radiographic dye study occurred in 227 pediatric oncology patients with 254 central venous catheters during a 1-year period. Fourteen of 58 catheters failed to clear after two bolus instillations of urokinase (5,000 U and 10,000 U). Thirteen catheters were treated for 24 hours with urokinase, 200 U/kg/h, and one catheter with urokinase, 100 U/kg/h for 24 hours. Twelve catheters were used for study. Coagulation studies were monitored preinfusion, 12 hours into the infusion, and postinfusion. Patency was reestablished in 11/12 catheters (92%) with a mean infusion time of 28.7 hours. No coagulation abnormalities or clinical bleeding associated with the urokinase infusion occurred. Only one patient exhibited a prolonged partial thromboplastin time (greater than 150 seconds); this was associated with a heparin effect. These data indicate that low-dose urokinase may be a safe and effective means to clear occluded central venous catheters in children.
AuthorsH A Bagnall, E Gomperts, J B Atkinson
JournalPediatrics (Pediatrics) Vol. 83 Issue 6 Pg. 963-6 (Jun 1989) ISSN: 0031-4005 [Print] United States
PMID2657625 (Publication Type: Journal Article)
Chemical References
  • Urokinase-Type Plasminogen Activator
Topics
  • Blood Coagulation (drug effects)
  • Catheterization, Central Venous (adverse effects)
  • Child
  • Child, Preschool
  • Drug Evaluation
  • Dye Dilution Technique
  • Heart Atria
  • Humans
  • Infusions, Intravenous
  • Thrombosis (blood, diagnosis, drug therapy, etiology)
  • Time Factors
  • Urokinase-Type Plasminogen Activator (administration & dosage, adverse effects)

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