From the FDA Drug Label
CLINICAL STUDIES Three clinical studies were performed in patients with improperly functioning central venous access devices (CVADs) A placebo‑controlled, double‑blind, randomized trial (Trial 1) and a larger open‑label trial (Trial 2) investigated the use of Alteplase in predominately adult patients who had an indwelling CVAD for administration of chemotherapy, total parenteral nutrition, or long‑term administration of antibiotics or other medications Patients with hemodialysis catheters or a known mechanical occlusion were excluded from both studies Also excluded were patients considered at high risk for bleeding or embolization (see PRECAUTIONS, Bleeding), as well as patients who were younger than 2 years old or weighed less than 10 kg.
The Alteplase (IV) can be used to dissolve vascular occlusions.
- It is used for catheter clearance in patients with central venous access devices.
- The dose is 2 mg/2 mL instilled into the catheter lumen.
- Restoration of function is assessed at 30 minutes and 120 minutes after administration of each dose. 1
From the Research
Hyaluronidase is the primary agent used to dissolve vascular occlusions caused by Platelet-Rich Plasma (PRP) gel. When a vascular occlusion occurs, immediate treatment with high-dose hyaluronidase (typically 150-300 units) should be administered directly into the affected area. Multiple injections may be necessary, with doses repeated every 1-2 hours until circulation improves. Warm compresses should be applied to the area to promote vasodilation, and gentle massage may help distribute the enzyme. Hyaluronidase works by breaking down hyaluronic acid components in the PRP gel, effectively dissolving the occlusion and restoring blood flow. This enzyme specifically targets the glycosaminoglycan bonds that contribute to the gel-like structure of PRP when it forms a clot. Prompt treatment is essential as prolonged occlusion can lead to tissue necrosis. Patients should be monitored closely after treatment for signs of improved circulation such as return of normal color and capillary refill. In severe cases, additional treatments like low-molecular-weight heparin or aspirin may be considered to prevent further clotting, as suggested by studies such as 2 and 3. However, the most recent and highest quality study 4 does not directly address the use of hyaluronidase in this context, but it discusses the development of novel thrombolytic agents, highlighting the ongoing need for effective treatments for vascular occlusions. Given the available evidence and the need for prompt treatment to prevent morbidity and mortality, hyaluronidase remains the recommended treatment for dissolving vascular occlusions caused by PRP gel. Key considerations in treatment include:
- Prompt administration of high-dose hyaluronidase
- Monitoring for signs of improved circulation
- Potential use of additional treatments to prevent further clotting
- The importance of preventing tissue necrosis through timely intervention.