Regional Thrombolysis with Urokinase for Central Venous Catheter-related Thrombosis in Patients Undergoing High-dose Chemotherapy with Autologous Blood Stem Cell Rescue

Abstract

Fifty-one of 300 patients undergoing high-dose chemotherapy with (n = 245) or without (n = 55) autologous stem cell rescue developed central venous catheter-related thrombosis diagnosed by Doppler sonography or contrast ve nography. Eighteen of these individuals underwent regional thrombolysis defined as the infusion of urokinase into a super ficial vein of the ipsilateral upper extremity in a dose not suf ficient to produce systemic fibrinolysis by laboratory criteria. Urokinase was administered at a dose of 75,000-150,000 U/hour for 24 to 96 hours and contrast venography was per formed to assess response. All individuals had a partial or complete resolution of clinical signs and symptoms. Fifty per cent of patients also achieved a partial radiographic response defined as clot lysis with irregular canalization of the vein. Therapeutic doses of heparin for 5 to 7 days and warfarin for at least 3 months were commenced at the conclusion of urokinase therapy. Twelve catheters were salvaged and utilized subse quently until no longer required. Six catheters were removed because of poor catheter function or rethrombosis. The median interval from diagnosis of the thrombus until extraction of the 12 salvaged catheters was 3 months (range 1-8 months). Only a single patient who developed gastrointestinal bleeding re quired discontinuation of urokinase. Regional thrombolysis is safe, easy to administer, effective in many instances, less costly than the doses of antifibrinolytic agents required to induce sys temic fibrinolysis, and should be considered in patients receiv ing high-dose chemotherapy with autologous stem cell rescue who develop central venous catheter-related thrombosis. Key Words: Regional thrombolysis—Urokinase—Catheter—related thrombosis.