2011 Top Game Changers in Nephrology

George Bakris, MD; Jeffrey S. Berns, MD; Lynda A. Szczech, MD; Carol Peckham

Disclosures

November 16, 2011

In This Article

7. Rt-PA Beats Heparin -- But Will Bundling Lock it Out?

A trial reported by Hemmelgarn and colleagues[5] compared lock solutions of rt-PA to standard heparin on the frequency of catheter malfunction and episodes of catheter-related bacteremia. In her Medscape Viewpoint, Lynda Szczech wrote, "Catheter malfunction was the primary outcome. Patients in the heparin group were more likely to experience catheter malfunction than those in the rt-PA group. Similarly, patients in the rt-PA group experienced catheter-related bacteremia at a lesser rate than those in the heparin group. Intuitively, safety (particularly with respect to episodes of bleeding) should be a major consideration on whether to adopt rt-PA and should be balanced against the efficacy of this therapy. Bleeding was examined carefully. Neither the frequency nor the severity of bleeding events differed between groups and, further, all 4 intracranial bleeding episodes (including 1 event that was fatal) were in the heparin group. No subjects in the rt-PA group experienced an intracranial bleed. Much has been written about how the new bundled payment system may affect the provision of dialysis in the United States. Given the constraints of the reimbursement and the inclusion of all medications given in the dialysis unit, concerns have been expressed that the new bundled payment system may stifle innovation, such as this novel use of rt-PA given, that there is no 'room to pay' for anything additional. As we watch the extent to which these and other new expensive therapies become adopted, we must keep in mind that in the absence of a scientific or safety signal that precludes their use, this may be a test of the effect of the payment system on innovation."

Read the complete Viewpoint on this study from Lynda Szczech, MD.

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