Faculty Collaboration Database

Prophylactic rtPA in the Prevention of Line-associated Thrombosis and Infection in Short Bowel Syndrome. J Pediatr Gastroenterol Nutr 2018 Jun;66(6):972-975

Date

11/15/2017

Pubmed ID

29135819

DOI

10.1097/MPG.0000000000001836

Scopus ID

2-s2.0-85048199342 (requires institutional sign-in at Scopus site)   7 Citations

Abstract

BACKGROUND: Central venous access devices (CVADs) are essential for total parenteral nutrition administration in patients with short bowel syndrome (SBS). They are, however, fraught with complications including infection and venous thromboembolism (VTE), which increases associated morbidity and mortality in this population. There is evidence linking the development of CVAD-associated thrombosis and line-related infection. Thus, it has been postulated that prevention of catheter-related clot formation could minimize the risk of infection originating from the catheter. Recombinant tissue plasminogen activator (rtPA, alteplase), lyses clots by binding plasmin-bound fibrin in a clot and cleaving plasminogen to plasmin; moreover, it is widely used to clear occluded CVADs.

METHODS: Prophylactic rtPA lock therapy in children with SBS was evaluated as a single site pilot study to minimize line-associated VTE, infection, need for line replacement, and hospitalization at the Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center. rtPA lock therapy was administered by parents/caregivers on a weekly basis over a 6-month time period in place of heparin lock therapy. Comparisons were made between line-associated complications in the cohort in the 6 months before study versus during the study period.

RESULTS: Six out of 8 subjects completed the study over a 1-year time period. As a group, subjects experienced a significant decrease in the number of line-associated bloodstream infections from a mean of 1.9 infections in the 6 months before the study to a mean of 0.5 infections (P = 0.025). There was no change in the need for line replacement amongst subjects while on study. The primary outcome of VTE was not found in the cohort, and it is unclear whether rtPA lock therapy contributed to the lack of thrombosis development. Given the success of rtPA in this pilot study in reducing bloodstream infections, further investigation or rtPA lock therapy in patients with SBS is warranted.

Author List

Malec LM, Cooper J, Rudolph J, Michaels MG, Ragni MV

Author

Lynn M. Malec MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Catheter Obstruction
Catheter-Related Infections
Catheterization, Central Venous
Child
Child, Preschool
Female
Fibrinolytic Agents
Humans
Male
Parenteral Nutrition, Total
Pilot Projects
Prospective Studies
Short Bowel Syndrome
Thrombosis
Tissue Plasminogen Activator
Treatment Outcome