Prophylactic urokinase in the management of long-term venous access devices in children: A Children's Oncology Group study

Peter W. Dillon, Gary R. Jones, Holly A. Bagnall-Reeb, Jonathan D. Buckley, Eugene S. Wiener, Gerald M. Haase

Research output: Contribution to journalArticle

75 Scopus citations

Abstract

Purpose: Infection and thrombosis are serious-complications of long-term vascular access devices in children undergoing chemotherapy. Since routine fibrinolytic therapy may decrease these complications, the purpose of this study was to compare the efficacy of an every-2-week administration of urokinase with standard heparin flushes in reducing the incidence of device-related infections and occlusions. Materials and Methods: This study was a prospective, randomized phase III multicenter trial conducted by the Children's Cancer Group, in which patients with implantable ports or tunneled catheters received either urokinase or heparin every 2 weeks for 12 months. Study end points were time to first occlusion or time to first device-related infection. Results: Five hundred seventy-seven patients from 29 institutions were enrolled, of whom 51% had external catheters and 49% had ports. Urokinase administration resulted in fewer occlusive events than heparin (23% v 31%; P = .02), a longer time to first occlusive event (log-rank analysis, P = .006), and a 1.6-fold difference in the rate of occlusive events (Poisson regression, P = .003). Similar results were noted when comparing ports and tunneled catheters. The urokinase group also had a 1.4-fold difference in the rate of infection (Poisson regression, P = .05) and longer time to first infection (log-rank, P = .07), but the difference was significant only in tunneled catheters. Conclusion: Urokinase administration every 2 weeks significantly affects the rate of occlusive events in ports and tunneled catheters and of infectious events in external catheters compared with heparin administration.

Original languageEnglish (US)
Pages (from-to)2718-2723
Number of pages6
JournalJournal of Clinical Oncology
Volume22
Issue number13
DOIs
StatePublished - Dec 1 2004

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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