What is the prevalence of thrombotic occlusion of central venous access devices (CVADs) and what is the success rate of thrombolytic therapy in reopening devices?

Updated: Dec 31, 2017
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Central venous access devices (CVADs) are an important component of long-term treatments that require ongoing venous access and regular maintenance. They are subject to malfunctions, such as thrombotic occlusion with an incidence range from 2-40%. Risk factors include type of malignancy, type of chemotherapy, type of CVAD, insertion site, and type of catheter tip. Mechanical central venous catheter occlusions call for cause-specific treatment, whereas thrombotic occlusions usually resolve with thrombolytic treatment. [40]

Thrombolytic therapy has reopened occluded catheters in 85-90% of episodes, and removal of the catheter is not usually required. Alteplase, urokinase, and streptokinase have all been used. Streptokinase is not commonly used, because of its antigenic properties and allergic reactions. Urokinase was off the market for a time; it is now available again but is not approved for clearance of occluded catheters.

Newer forms of thrombolytic therapy, such as reteplase and tenecteplase, effectively treat central venous catheter occlusion and require shorter dwell times than alteplase. Further studies are needed to compare alteplase with newer thrombolytic agents to determine optimal management for catheter occlusion. [41]

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