Efficacy, Safety, and Cost of Thrombolytic Agents for the Management of Dysfunctional Hemodialysis Catheters

A Systematic Review

Daniel Hilleman, Pharm.D., FCCP; Jennifer Campbell, Pharm.D.


Pharmacotherapy. 2011;31(10):1031-1040. 

In This Article


Thrombolytic therapy is commonly used to treat dysfunctional hemodialysis catheters. Currently, no thrombolytic agent is specifically FDA approved to treat thrombosed hemodialysis catheters, but alteplase is available in a 2-mg/ml vial indicated for central venous catheter clearance. Of the 18 trials considered in this systematic review, most included data that were observational or collected retrospectively. None of the trials compared one thrombolytic agent directly with another. The average catheter clearance success rates were generally similar for alteplase (81%) and reteplase (88%), whereas the success rate with tenecteplase was substantially lower (41%). The reasons for the lower success rate with tenecteplase are not known. None of the thrombolytics were associated with adverse effects, most likely because of limited systemic exposure to drug. Reteplase is currently used for hemodialysis catheter clearance by using an aliquot method requiring sterile preparation. Despite this limitation, the cost of delivering a dose of reteplase is $40 lower per treatment episode than alteplase. This cost advantage may be of sufficient importance at high-volume dialysis centers to influence drug product selection.