Occluded central venous catheters

A solution of urokinase 5000 IU in 1 ml of saline is used for clearance of central intravenous cannulas. Monitoring fibrinolytic therapy

Thrombolytic agents produce their effects by inducing and amplifying activation of the plasminogen-plasmin proteolytic enzyme system and thus are a potentially dangerous group of pharmaceutical agents. As it is difficult to assay plasmin directly, the detection of circulating fibrin degradation products confirms activation of the fibrinolytic system. Baseline levels are necessary for reference as natural activation occurs in association with arterial and venous thrombosis. A degree of cleavage of fibrinogen also may occur with fibrinolytic therapy, resulting in the generation of fibrinogen degradation products. These degradation products inhibit the thrombin conversion of fibrinogen to fibrin, as can be measured using the thrombin clotting time. Fibrinogen levels may also fall during therapy. Collection of blood samples on aprotinin (150 to 200 IU/ml) minimizes continued in vitro lysis which can result in spurious results.

When using fibrinolytic therapy the following questions usually arise.

1. Are there clinical or other objective measures of thrombus dissolution?

2. Which laboratory indices are useful in confirming activation of the fibrinolytic system?

a. thrombin time b. fibrin degradation products c. fibrinogen level

3. Which laboratory measurements may be predictive of hemorrhagic complications? In general, tests are not of value in this respect and have a greater role after the event in determining the cause and appropriate therapy.

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