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Observational Study of Need for Thrombolytic Therapy and Incidence of Bacteremia using Taurolidine‐Citrate‐Heparin, Taurolidine‐Citrate and Heparin Catheter Locks in Patients Treated with Hemodialysis
Author(s) -
Solomon Laurie R.,
Cheesbrough John S.,
Bhargava Ramya,
Mitsides Nicos,
Heap Michael,
Green Gerwyn,
Diggle Peter
Publication year - 2011
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2011.00951.x
Subject(s) - medicine , heparin , bacteremia , thrombolysis , hemodialysis , hazard ratio , catheter , hemodialysis catheter , surgery , confidence interval , myocardial infarction , antibiotics , microbiology and biotechnology , biology
Catheter‐related blood stream infections may be reduced by interdialytic locking with Taurolidine, a nontoxic antimicrobial agent. A formulation of 1.35% Taurolidine in 4% citrate (TC) is associated with a greater need for thrombolysis to maintain catheter patency than 5000 U/ml heparin. Our aim was to determine whether addition of 500 Units/ml of heparin to TC reduces the need for thrombolysis. TCH (1.35% taurolidine, 4% citrate and 500 U/ml heparin) was compared to TC and Heparin 5000 U/ml using retrospective data. Hundred and six adult hemodialysis patients with internal jugular tunnelled intravascular catheters using TCH were compared with 34 patients using TC and 34 patients using heparin 5000 U/ml respectively. Outcomes were time to first use of thrombolysis and bacteremia rates.TCH reduced the need for thrombolysis compared to TC (hazard ratio, 0.2; 95%CI: 0.06, 0.5; p < 0.001 ) and was not significantly different from heparin 5000 U/ml (hazard ratio, 1.4; 95%CI: 0.5, 3.9; p = 0.5). The bacteremia rates from all causes were 1.33, 1.22 and 3.25 per 1000 catheter‐ days ( p < 0.001 ) in the TCH, TC and heparin groups respectively. Addition of 500 U/ml heparin to TC reduces the need for thrombolysis without increasing bacteremia and may achieve patency comparable to heparin 5000 U/ml.