What is the role of Alteplase (Activase) in managing Peripherally Inserted Central Catheter (PICC) line occlusions?

From the Guidelines

Alteplase (Activase) plays a crucial role in managing Peripherally Inserted Central Catheter (PICC) line occlusions, particularly those caused by blood clotting.

Treatment of Thrombotic Catheter Occlusion

• Alteplase is the recommended agent for treating thrombus-occluded catheters, with a strong recommendation and consensus 1.
• The dose of alteplase used to restore catheter patency is typically 0.5-2 mg, with dwell times ranging from 30 to more than 240 min 1.
• Repeated doses of alteplase may be necessary if patency is not restored, with an overall efficacy ranging from approximately 50% to 90% 1.

Efficacy and Safety

• Studies have shown that alteplase can clear 52% of obstructed catheters within 30 min, with an overall clearance of 86% after 2 doses if necessary 1.
• Alteplase has been found to be safe and effective in both adult and pediatric patients, with no significant side effects reported in clinical trials 1.

Comparison with Other Fibrinolytics

• Alteplase is preferred over urokinase due to its fibrin specificity, low immunogenicity, and improved clot lysis in vitro 1.
• Newer medications such as reteplase, tenecteplase, and alfimeprase may have higher efficacy or shorter time to clearance, but more research is needed to confirm their effectiveness 1.

From the FDA Drug Label

Cathflo® Activase® (Alteplase) is indicated for the restoration of function to central venous access devices as assessed by the ability to withdraw blood. The role of Alteplase (Activase) in managing Peripherally Inserted Central Catheter (PICC) line occlusions is to restore function to the catheter by dissolving occlusions, as evidenced by the ability to withdraw blood and infuse saline through the catheter.

• The drug label reports that in clinical trials, Alteplase was effective in restoring function to occluded central venous access devices, including PICC lines, in a significant proportion of patients 2.
• The overall rate of catheter function restoration was 85% after up to two doses of Alteplase 2.
• Alteplase is indicated for the restoration of function to central venous access devices, including PICC lines, as assessed by the ability to withdraw blood 2.

From the Research

Role of Alteplase in Managing PICC Line Occlusions

• Alteplase, also known as Activase, is used to restore function to occluded central venous access devices, including Peripherally Inserted Central Catheter (PICC) lines 3, 4, 5.
• The efficacy of alteplase in restoring PICC line patency has been demonstrated in several studies, with success rates ranging from 75% to 94.4% after one or two doses 4, 5.
• Alteplase has been shown to be safe and effective in pediatric patients, with no incidents of intracranial hemorrhage reported in a study of 310 patients 3.
• The use of low-dose alteplase (1 mg/1 mL) has been found to be effective and cost-effective in clearing occluded PICC lines, with a success rate of 93.3% 4.
• Alteplase has also been used to treat occlusions in other types of central venous catheters, including hemodialysis catheters, with success rates of 72% to 83% 6.

Dosage and Administration

• The typical dose of alteplase for treating PICC line occlusions is 1-2 mg/1-2 mL, administered intraluminally and allowed to dwell for 30-120 minutes 4, 5.
• The use of a maximum of two doses of alteplase has been found to be effective in restoring PICC line patency, with minimal risk of adverse events 5.
• The administration of alteplase can be repeated if necessary, with some studies suggesting the use of 1 mg of alteplase, repeated once if necessary, for midline catheters 7.

Safety and Efficacy

• Alteplase has been found to be safe and effective in restoring PICC line patency, with minimal risk of adverse events, including intracranial hemorrhage, embolic events, and gastrointestinal bleeding 3, 5.
• The use of alteplase has been found to reduce the need for radiological or surgical interventions, and to preserve vein health 7.
• The cost-effectiveness of alteplase in treating PICC line occlusions has been demonstrated, with significant cost savings reported in some studies 4, 6.