Abstract: TH-PO0515
Tissue Plasminogen Activator 1 mg vs. 2 mg per Lumen Dose for Hemodialysis Catheter Dysfunction
Session Information
- Dialysis: Novel Therapeutics and Medication Management
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Shieu, Monica, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Li, Nien Chen, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Harford, Antonia, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Hsu, Caroline M., Tufts Medical Center, Boston, Massachusetts, United States
- Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
- Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
- Johnson, Doug, Dialysis Clinic Inc, Nashville, Tennessee, United States
- Lacson, Eduardo K., Dialysis Clinic Inc, Nashville, Tennessee, United States
- Manley, Harold, Dialysis Clinic Inc, Nashville, Tennessee, United States
Background
Optimal tissue plasminogen activator (tPA) dose for hemodialysis (HD) central venous catheter (CVC) dysfunction is unknown. We evaluated the efficacy of tPA dose (1mg vs 2mg/lumen) for CVC dysfunction in a national dialysis cohort.
Methods
The retrospective cohort included adult maintenance patients on in-center HD who received tPA for CVC from 1/12/2024-3/31/2025. The 30-day CVC failure was defined as any of the following: additional tPA use, CVC replacement, inability to sustain blood flow rate (BFR)≥300 mL/min, or early termination of HD session due to CVC dysfunction. The primary patency outcome was repeated tPA use or CVC replacement and the secondary patency outcome was CVC replacement. Kaplan-Meier survival analysis and Cox regression models were used to compare the rate of tPA dose with primary and secondary outcomes of CVC dysfunction, adjusted for patient and clinical characteristics.
Results
Among 1202 patients with median (IQR) follow-up of 17 (4,30) days, 61% of patients received 1mg tPA and 39% received 2mg tPA. For the 30-day CVC function, outcomes were similar with tPA 1mg and 2mg [350 (48%) vs 203 (43%) (Figure); aHR=1.1 (0.9-1.3)]. Primary patency results were similar (aHR=1.1, 0.9-1.4). However, for secondary patency, tPA 1mg was associated with earlier catheter replacement [median difference=7 days; aHR=1.2 (1.0-1.5)]. The distributions of repeated tPA use, low BFR, and early termination were similar between dose groups.
Conclusion
tPA 2mg and 1mg was similarly effective in resolving immediate CVC dysfunction, with 2mg only delaying CVC replacement by a week on average. Due to high cost, tPA 2mg dose may be reserved for patients in whom extending the CVC patency prior to the need for replacement is critical. Further research is needed to optimize tPA usage when treating CVC dysfunction.