Thrombolyse to dialyse

File:Central line equipment.jpg

If you’ve been involved in dialysis before, you’ll know that one of the most frustrating problems is having their dialysis access clot off or thrombose. Usually after having their device accessed, it’s locked off with heparin – but how bout using tPA once a week instead?

This 225 patient study from NEJM looked at replacing one of the heparin locks with tPA instead, keeping the other two sessions as heparin only. This almost halved the chance of catheter malfunction and also reduced rates of bacteraemia. In terms of adverse events, the rates of bleeding seemed similar. 

So, is this going to become standard practice for patients with catheters for dialysis? Maybe – but it’s important to note that this trial was funded by Hoffman LaRoche, who do make rtPA. 

Read about this idea here

IMAGE: Clinical Cases


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