Use of tissue plasminogen activator for reopening of clotted dialysis catheters.

The use of central venous catheters as permanent vascular access in chronic hemodialysis is complicated by clotting. We have tried a nonallergenic thrombolytic agent, tissue plasminogen activator (t-PA), to dissolve catheter luminal thrombosis. Eight patients, 7 in chronic hemodialysis and 1 treated by immune adsorption had 18 treatments with locally applied t-PA (2 mg/2 cm3). Fifteen out of 16 treatments with longer bolus dwell than 60 min were successful. No side effects occurred. t-PA dissolves clot formation efficiently and safely, the drug is nonallergenic and can therefore be given repeatedly.