I do acute dialysis in several hospitals. Since Uro is off the market we are trying to find something to help clear catheters. One hospital is allowing the use of TPA in 2mg doses. I used TPA in a catheter Friday. The pts ACT prior to the TPA was 105. After 2 doses of TPA it was only 65. When I worked in CCU we were concerned about a rebound hypercoagulation in MI pts that received TPA. Is this what is happening here also? Does anyone have any info on this yet? The hospital that is allowing the use of TPA admits that it took an educated guess at the dose to use. Maybe a combo of TPA and Heparin in the catheter or clotted graft would combat the coagulation problem. Any information would be greatly appreciated.

Kathy

Can you explain what TPA is ? I am not familiar with this. Is it an alternative to Urokinase ? What does it cost ? Can it be used in the out patient setting ? Anything published about it anywhere ?

Thanks !

TPA is tissue plasminagin activator. It is the same clot dissolving medication that is used for people having a heart attack or stroke. Catheter clearance and graft declotting are off formulary useage at this point. The hospital that does use it is experimenting as to the dose. The pharmacy is freezing syringes with 2mg/2cc of the med and we are trying that for cath clearance. I haven't found any research on it and the 2mg dose is an educated guess. One problem we have run into with the graft declots is they don't remain open. TPA does induce a rebound hypercoagulation in heart attack pts so we always had to give systemic heparin. That maybe what is happening here also, we just don't know. The last catheter I tried to use TPA on I asked the doc about trying a mix of TPA and Heparin. The catheter was loaded with 1mg of TPA and the rest Heparin 1:10,000. This seemed to work better and when I saw the pt in the outpt center the catheter was working better. Not perfect but it was working. As far as cost I have no idea but for heart attack pts the cost is extremely high.

Kathy

Maybe, I am misunderstanding you, but it sounds as if you infuse the TPA into the catheter, 2mg/2ml, regardless of catheter volume.

We infuse TPA in a volume = the catheter volume only, and then aspirate it. Never infuse. In fact, we let it dwell < 30 seconds. Our IVT team has been using TPA on PICCs, Groshong catheters, et cetera, with good results thus far.

We have a Negative Pressure Instillation Protocol, let me know if you want to see it and I will get it to you!

The TPA we are using is only up to the limb load. So far the long term catheters I had to use it on had limb load more then 2cc. The pharmacy that is trying this suggest letting the TPA dwell for an hour then aspirating. Repeat with another dose of TPA and wait another hour. You are having good success with dwelling < 30 secs? I would love to see anything you had. As I said all of this is so far an educated guess for us.

Kathy

TPA is being used. A protocols of the 2cc frozen syringes sound like the most common being used around the US and in Canada. Would love to know what the cost is for the 2cc's.