Variables Leading to Usage of Alteplase Versus Heparin Lock in Patients With Tunneled Catheters in Hemodialysis Care Project Centers, Saudi Arabia.

Autor:	Alhammouri J; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Riyadh, SAU.; Research Office, King Abdullah International Medical Research Center, Riyadh, SAU.; Research Office, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU., Ockhuis D; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Riyadh, SAU., Hibionada E; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Riyadh, SAU., Albalawi M; Biostatistics, King Abdullah International Medical Research Center, Riyadh, SAU., Alnahdi R; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Jeddah, SAU., Hikal B; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Madinah, SAU., Koko E; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Makkah, SAU., Alano MML; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Hail, SAU., Troncoso M; Hemodialysis Care Project, Ministry of National Guard Health Affairs, Riyadh, SAU., Hashmi MN; Nephrology, Ministry of National Guard Health Affairs, Jeddah, SAU.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 May 21; Vol. 16 (5), pp. e60817. Date of Electronic Publication: 2024 May 21 (Print Publication: 2024).
DOI:	10.7759/cureus.60817
Abstrakt:	Introduction: A hemodialysis tunneled catheter is one option for vascular access used with hemodialysis patients; however, catheter complications such as thrombosis are still inevitable. To prevent thrombosis formation, a catheter-locking solution is instilled between dialysis sessions. Heparin is used as a default locking solution in our Hemodialysis Care Project centers, while a recombinant tissue plasminogen activator (rt-PA) such as alteplase is used to treat suspected catheter thrombosis. This study aimed to identify the clinical factors, catheter brands, and hemodialysis variables that influence the choice of use for alteplase versus heparin, for those patients with tunneled catheters, and reduce overprescribing of high-alert medication alteplase. Methods: A retrospective medical chart review study was conducted involving 230 patients with tunneled catheters; the first group of 133 patients used alteplase regularly three times a week, while the second group of 97 patients completed at least one year using the same catheter access with heparin lock only. Results: Multivariate logistic regression and logistic regression analysis showed a significant association (p < 0.05) between different variables. Results suggest that overweight and hyperlipidemia patients are more likely to use alteplase. Patients using brand-name catheters such as Hemostar/Vas-cath (BD, Franklin Lakes, NJ) are less likely to use heparin than those using Medcomp catheters (Medcomp, Yuma, AZ). In addition, patients having a history of angioplasty would be less likely to have heparin than no angioplasty. Moreover, if the patient's fluid removal were equal to or less than 2 kg, they would be more likely to use heparin and vice versa. Conclusion: The study postulates that identified variables affect whether alteplase or heparin is used in hemodialysis tunneled catheters, and may be useful to increase awareness, improve practices, or judiciously control the use of alteplase within Saudi Arabia and globally. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2024, Alhammouri et al.)
Databáze:	MEDLINE
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