Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: a randomised controlled trial.
Randomized controlled trial published in Archives of disease in childhood (2006)
Abstract
OBJECTIVES: To determine whether the tissue plasminogen activator, alteplase, is more effective than heparin in preventing blood clots developing in children's haemodialysis central lines between dialysis sessions. DESIGN: A prospective double-blind, within-patient multiperiod cross-over controlled trial of instilling a "lock" of either heparin 5000 U/ml or alteplase 1 mg/ml into the central lines of two children haemodialysed twice weekly, and seven dialysed thrice weekly, over 10 weeks. SETTING: A UK paediatric nephrology unit. MAIN OUTCOME MEASURES: Weight of blood clot aspirated from the line at the start of the next dialysis session. RESULTS: The odds of a clot forming was 2.4 times greater with heparin than alteplase (95% CI 1.4 to 4.0; p = 0.001), and when present they were 1.9 times heavier (31 vs 15 mg; 95% CI 1.5 to 2.4; p<0.0005). There was no effect of inter-dialytic interval. One child required an alteplase infusion to clear a blocked line following a heparin lock. We subsequently changed our routine locks from heparin to alteplase. Comparing the year before and after that change, the incidence of blocked lines requiring an alteplase or urokinase infusion fell from 2.7 to 1.2 per child (p<0.03), and the need for surgical replacements from 0.7 to nil (p<0.02). CONCLUSION: Alteplase is significantly more effective than heparin in preventing clot formation in central haemodialysis lines. This reduces morbidity and improves preservation of central venous access. It is more expensive, though relatively economic if packaged into syringes and stored frozen until needed, but reduces the costs of unblocking or replacing clotted lines.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
To determine whether the tissue plasminogen activator, alteplase, is more effective than heparin in preventing blood clots developing in children's haemodialysis central lines between dialysis sessions. A prospective double-blind, within-patient multiperiod cross-over controlled trial of instilling...
Por qué esto importa para la hirudoterapia
Este ensayo prospectivo, doble ciego, controlado multperiodo cruzado intra-paciente, comparó alteplasa frente a heparina como soluciones de lock para prevenir la formación de coágulos sanguíneos en las líneas de hemodiálisis venosa central pediátrica en nueve niños durante 10 semanas. El resumen informa de que la alteplasa fue significativamente más eficaz que la heparina, con una odds 2,4 veces menor de formación de coágulos y coágulos más ligeros cuando estaban presentes. El estudio examina el manejo de la anticoagulación farmacológica de los catéteres de diálisis. El resumen no contiene ninguna mención a sanguijuelas, hirudoterapia ni compuestos derivados de sanguijuelas, por lo que su relevancia para el dominio de ASH es completamente indirecta, limitada únicamente a antecedentes contextuales sobre el uso de anticoagulantes en un entorno clínico.
Citación
Comparison of alteplase and heparin in maintaining the patency of paediatric central venous haemodialysis lines: a randomised controlled trial.
Gittins et al. · Archives of disease in childhood, 2006
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: 18 de junio de 2026