Management of dialysis catheter-related thrombus

PURPOSE OF REVIEW: The goal of this review is to provide a comprehensive update on the clinical manifestations and medical management of intraluminal hemodialysis catheter thrombosis and central vein stenosis and thrombosis related to hemodialysis catheters. RECENT FINDINGS: The two thrombolytic agents used most frequently to treat dialysis catheter dysfunction, alteplase and urokinase, have a similar immediate efficacy of about 80%. A 2 mg per lumen dose of alteplase is superior to a 1 mg per lumen dose, and a 30-min instillation is as effective as a longer instillation time. Restoration of catheter function after instillation of a thrombolytic agents is often short-lived. Catheters with intra-luminal thrombosis frequently require repetitive thrombolytic instillation, and many patients ultimately require catheter exchange when instillation of a thrombolytic agent is no longer effective. Central vein stenosis and thrombosis are seen in about 25% of patients with a hemodialysis catheter. They are often recurrent, and the role of anticoagulation is uncertain. SUMMARY: Clinicians should recognize the clinical manifestations and medical management of hemodialysis catheter-related thrombosis and its management. We need more research to better understand whether anticoagulation is indicated in central vein thrombosis.