Monthly recombinant tissue plasminogen activator administration to implantable central venous access devices decreases infections in children with haemophilia. 2009

M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
Department of Paediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. mjeng@stanford.edu

Central venous access devices (CVAD) have been effectively used in the care of haemophilia patients. This is particularly true in children, who often have difficult venous access. CVAD complications (infection and thrombosis), risk factors, and complication rates, have been well-documented. However, effective interventions which decrease complication rates have not been identified. In this study, we review our experience with the use of monthly recombinant tissue plasminogen activator (rtPA) administration in haemophilia patients with fully implanted CVADs. Data on 19 haemophilia patients with 24 CVADs were available for analysis, with a total of 24 520 CVAD days. An infection rate of 0.04 infections per 1000 CVAD days and a thrombosis rate of 0.04 thrombi per 1000 CVAD days was observed. The observed infectious complication rate is at least one logarithm lower than many published CVAD infection rates in haemophilia patients who have not received rtPA administration. No bleeding complications were noted. Monthly rtPA is safe and appears to be effective in decreasing CVAD infection rates. Larger, randomized controlled studies are indicated to validate this finding.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D008297 Male Males
D010959 Tissue Plasminogen Activator A proteolytic enzyme in the serine protease family found in many tissues which converts PLASMINOGEN to FIBRINOLYSIN. It has fibrin-binding activity and is immunologically different from UROKINASE-TYPE PLASMINOGEN ACTIVATOR. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases. Alteplase,Plasminogen Activator, Tissue-Type,T-Plasminogen Activator,Tissue-Type Plasminogen Activator,Actilyse,Activase,Lysatec rt-PA,TTPA,Tisokinase,Tissue Activator D-44,Lysatec rt PA,Lysatec rtPA,Plasminogen Activator, Tissue,Plasminogen Activator, Tissue Type,T Plasminogen Activator,Tissue Activator D 44,Tissue Type Plasminogen Activator
D011994 Recombinant Proteins Proteins prepared by recombinant DNA technology. Biosynthetic Protein,Biosynthetic Proteins,DNA Recombinant Proteins,Recombinant Protein,Proteins, Biosynthetic,Proteins, Recombinant DNA,DNA Proteins, Recombinant,Protein, Biosynthetic,Protein, Recombinant,Proteins, DNA Recombinant,Proteins, Recombinant,Recombinant DNA Proteins,Recombinant Proteins, DNA
D002405 Catheterization, Central Venous Placement of an intravenous CATHETER in the subclavian, jugular, or other central vein. Central Venous Catheterization,Venous Catheterization, Central,Catheterization, Central,Central Catheterization,Catheterizations, Central,Catheterizations, Central Venous,Central Catheterizations,Central Venous Catheterizations,Venous Catheterizations, Central
D002408 Catheters, Indwelling Catheters designed to be left within an organ or passage for an extended period of time. Implantable Catheters,In-Dwelling Catheters,Catheter, In-Dwelling,Catheter, Indwelling,Catheters, In-Dwelling,In Dwelling Catheters,In-Dwelling Catheter,Indwelling Catheter,Indwelling Catheters
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D004866 Equipment Contamination The presence of an infectious agent on instruments, prostheses, or other inanimate articles. Contamination, Equipment,Contaminations, Equipment,Equipment Contaminations
D006467 Hemophilia A The classic hemophilia resulting from a deficiency of factor VIII. It is an inherited disorder of blood coagulation characterized by a permanent tendency to hemorrhage. Factor VIII Deficiency,Hemophilia,Autosomal Hemophilia A,Classic Hemophilia,Deficiency, Factor VIII,Factor 8 Deficiency, Congenital,Factor VIII Deficiency, Congenital,Haemophilia,Hemophilia A, Congenital,Hemophilia, Classic,As, Autosomal Hemophilia,Autosomal Hemophilia As,Classic Hemophilias,Congenital Hemophilia A,Congenital Hemophilia As,Hemophilia A, Autosomal,Hemophilia As,Hemophilia As, Autosomal,Hemophilia As, Congenital,Hemophilias, Classic

Related Publications

M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
July 2000, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
January 2002, Annals of Saudi medicine,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
March 2004, Haemophilia : the official journal of the World Federation of Hemophilia,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
August 1998, Metabolism: clinical and experimental,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
January 2008, Haemophilia : the official journal of the World Federation of Hemophilia,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
June 2009, Pediatric surgery international,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
October 2001, The Journal of pediatrics,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
September 1998, British journal of haematology,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
July 2015, Haemophilia : the official journal of the World Federation of Hemophilia,
M R Jeng, and M O'Brien, and W Wong, and J Zoland, and J Lea, and N Tang, and B Glader
March 1996, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis,
Copied contents to your clipboard!