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Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial
BACKGROUND: The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. METHODS: Prevalent hemodialysis patients f...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136626/ https://www.ncbi.nlm.nih.gov/pubmed/34015014 http://dx.doi.org/10.1371/journal.pone.0251793 |
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author | Bonkain, Florence Stolear, Jean-Claude Catalano, Concetta Vandervelde, Dominique Treille, Serge Couttenye, Marie M. Dhondt, Annemieke Libertalis, Mark Allamani, Mandelina Madhoun, Philippe Van Craenenbroeck, Amaryllis H. Vanommeslaeghe, Floris Van Hulle, Freya Durieux, Philippe Van Limberghen, Ingrid Tielemans, Christian Wissing, Karl Martin |
author_facet | Bonkain, Florence Stolear, Jean-Claude Catalano, Concetta Vandervelde, Dominique Treille, Serge Couttenye, Marie M. Dhondt, Annemieke Libertalis, Mark Allamani, Mandelina Madhoun, Philippe Van Craenenbroeck, Amaryllis H. Vanommeslaeghe, Floris Van Hulle, Freya Durieux, Philippe Van Limberghen, Ingrid Tielemans, Christian Wissing, Karl Martin |
author_sort | Bonkain, Florence |
collection | PubMed |
description | BACKGROUND: The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. METHODS: Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function. RESULTS: 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23–0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis. CONCLUSIONS: Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036255. |
format | Online Article Text |
id | pubmed-8136626 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-81366262021-05-27 Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial Bonkain, Florence Stolear, Jean-Claude Catalano, Concetta Vandervelde, Dominique Treille, Serge Couttenye, Marie M. Dhondt, Annemieke Libertalis, Mark Allamani, Mandelina Madhoun, Philippe Van Craenenbroeck, Amaryllis H. Vanommeslaeghe, Floris Van Hulle, Freya Durieux, Philippe Van Limberghen, Ingrid Tielemans, Christian Wissing, Karl Martin PLoS One Research Article BACKGROUND: The efficacy and cost-effectiveness of prophylactic thrombolytic locks in hemodialysis patients at high-risk of thrombotic dialysis catheter dysfunction is uncertain. We investigated this question in a double-blinded randomized controlled study. METHODS: Prevalent hemodialysis patients from 8 Belgian hemodialysis units, with ≥2 separate episodes of thrombotic dysfunction of their tunneled cuffed catheter during the 6 months before inclusion, were randomized to either: taurolidine heparin locks thrice weekly (control arm) or the same locks twice a week combined with taurolidine urokinase locks once a week before the longest interval without HD (TaurolockU arm). The primary efficacy outcome was the incidence rate of catheter thrombotic dysfunction requiring thrombolytic locks to restore function. RESULTS: 68 hemodialysis patients (32 controls, 36 urokinase) were followed during 9875 catheter days between May 2015 and June 2017. Incidence rate of thrombotic catheter dysfunction was 4.8 in TaurolockU vs 12.1/1000 catheter days in control group (rate ratio 0.39; 95%CI 0.23–0.64). 15/36 (42%) catheters in the treatment group required at least one therapeutic urokinase lock vs 23/32 (72%) in the control group (P = 0.012). The two groups did not differ significantly in catheter-related bloodstream infection and combined cost of prophylactic and therapeutic catheter locks. The TaurolockU group had a numerically higher number of episodes of refractory thrombosis. CONCLUSIONS: Prophylactic use of urokinase locks is highly effective in reducing the number of thrombotic catheter dysfunctions in catheters with a history of recurring dysfunction. Prophylactic use of urokinase locks did not reduce the overall costs associated with catheter locks and was associated with a numerically higher number of episodes of refractory thrombosis. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036255. Public Library of Science 2021-05-20 /pmc/articles/PMC8136626/ /pubmed/34015014 http://dx.doi.org/10.1371/journal.pone.0251793 Text en © 2021 Bonkain et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Bonkain, Florence Stolear, Jean-Claude Catalano, Concetta Vandervelde, Dominique Treille, Serge Couttenye, Marie M. Dhondt, Annemieke Libertalis, Mark Allamani, Mandelina Madhoun, Philippe Van Craenenbroeck, Amaryllis H. Vanommeslaeghe, Floris Van Hulle, Freya Durieux, Philippe Van Limberghen, Ingrid Tielemans, Christian Wissing, Karl Martin Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial |
title | Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial |
title_full | Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial |
title_fullStr | Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial |
title_full_unstemmed | Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial |
title_short | Prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: A randomized double-blind trial |
title_sort | prevention of tunneled cuffed catheter dysfunction with prophylactic use of a taurolidine urokinase lock: a randomized double-blind trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8136626/ https://www.ncbi.nlm.nih.gov/pubmed/34015014 http://dx.doi.org/10.1371/journal.pone.0251793 |
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