A Novel Method Of Six-Day Intensive Locking With Urokinase Combined With Heparin For Treatment Of Long-term Catheter Dysfunction:Efficacy And Safety Data From Thirty-six Patients

ObjectiveLong-term central venous catheter dysfunction seriously affects dialysis adequacy because of thrombosis and growth of fibrin sheath, which was a challenge to hemodialysis in clinic. In this study, we established a novel method to prevent and treat catheter dysfunction, named "Six-Day Intensive Locking with Urokinase Combined with Heparin ". The efficacy and safety of this method were observed.MethodsInclusion criteria:Regular hemodialysis patients with long-term central venous catheter were hospitalized for catheter dysfunction, and have received thrombolytic therapy with urokinase (Single thrombolytic treatment) before. Exclusion criteria: Patients with coagulation disorder or vein stenosis. Catheter dysfunction is defined as failure to attain a sufficient extracorporeal blood flow less than 200mI/min. Six-day Intensive treatment:urokinase (10000U/ml) used in daily moming(8:00) and heparin (1000U/ml) used in daily afternoon (16:00), lasted six days. Research programme: The time from patients firstly received thrombolysis treatment to their enrollment is considered as observation time. We observed the incidence of catheter dysfunction in the observation time as well as the equal observation time after the intensive therapy by a self-controlled method.ResultsA total of 36patients were enrolled, aged 60-89 years old, male 15 cases, female 21 cases; The observation time of prior treatment and post treatment was 170.4±92.7 days respectively. The rate of catheter dysfunction after intensive therapy is 9.87%%, which is significant lower than single therapy 50.75%(P<0.01). The first time to recurrence of catheter dysfunction was significantly shorter after single therapy compared with Intensive therapy(P<0.001). The successful declotting rates for catheter at three time points (the second, forth, and sixth injection urokinase/heparin) were29.41%、55.88% and 14.71% respectively. Besides, the study showed no significant difference on PT and APTT after intensive therapy.ConclusionsSix-Day Intensive Locking with Urokinase Combined with Heparin can treat catheter dysfunction and prevent recurrence of clotting episodes effectively, which is safe to application in clinic.