Fibrinolytic Agents for Restoration of Central Venous Catheter Patency: A Systematic Review.
Notice bibliographique
Résumé
Abstract Introduction. Thrombolytic agents are frequently used as an aid to restore catheter patency despite limited evidence supporting their use. We therefore conducted a systematic review to evaluate the efficacy of tPA (alteplase) and reteplase in restoring catheter patency. Methods. We searched MEDLINE (1999 to May Week 3 2007) and the Cochrane Controlled Clinical Trials Register (Second Quarter 2007) and performed a manual search for further studies. Studies published before 1999 were excluded since they have been previously reviewed; furthermore, most such studies used urokinase, which is no longer used to restore catheter patency in North America. Studies were included if they described the efficacy of alteplase or reteplase in restoring patency of central venous catheters (either for hemodialysis or infusional treatment) and where more than 5 thrombotic episodes were reported. This latter exclusion criteria was used to reduce the likelihood of bias likely to be found in very small case series. Two independent researchers abstracted total thrombolytic dose administered, dwell times, catheter patency rates and adverse event (including bleeding rates). For purposes of comparison, dwell times were stratified as ≤ 30 minutes and 30 to 120 minutes. Results. 25 articles were identified in the initial search, of which 17 met one or more exclusion criteria. Of the remaining 8 studies, 7 evaluated central venous catheters used for intravenous infusions and 1 study evaluated occluded hemodialysis catheters. Except for 1 randomized trial comparing thrombolytic agents to placebo in non-hemodialysis patients, all studies described uncontrolled cohorts or case series. The mean study size was 214 patients (range 6–995). At doses of 0.5–2.5 mg of alteplase, the range of catheter patency rates at dwell times of ≤ 30 minutes and 30 to 120 minutes were 52–54% (1301 total uses) and 69–91% (1466 total uses) respectively. In comparison when used with a ≤ 30 minute dwell time, reteplase was reported to restore catheter patency in 67–73% cases (154 total uses). In all reports bleeding complications attributed to thrombolytic therapy were uncommon. Conclusion. Our review suggests that the installation of alteplase or reteplase will restore catheter patency in more than 50% of cases when used with a dwell time of at least 30 minutes. Longer dwell times appear to increase patency rates. Reteplase may be more effective than alteplase, although this observation should be validated in an adequately powered clinical trial. Overall, although modern thrombolytic agents appear to provide catheter patency in the majority of patients, the evidence supporting their use is of low quality and is not based on the results of randomized trials.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,020 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,008 | 0,005 |
| Bibliométrie | 0,010 | 0,010 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».