Efficacy and Safety of Alteplase Use for Venous Catheter Thrombosis in Pediatric Patients―a Single Center Study
Koichi Kamei, Yuhi Takagi, Kentaro Nishi, Masao Ogura, Tetsuya Ishimaru, Naoki Shimojima, Akihiro Yoneda, Atsushi Tanioka, Ichiro Takeuchi, Hirotaka Shimizu, Katsuhiro Arai, Yoshihiro Gocho, Yuji Yamada, Daisuke Tomizawa, Kimikazu MatsumotoABSTRACT
Background
Urokinase is used as a thrombolytic agent to treat catheter thrombosis. However, since 2022, the supply of urokinase has diminished, and we have been using alteplase as an alternative, although its use for treating catheter thrombosis is off‐label in Japan.
Methods
We performed a single‐center, retrospective study on pediatric patients with central venous catheters (CVCs), peripherally inserted central catheters (PICCs), and central venous ports (CVPs) who received alteplase for catheter thrombosis at our facility (May 2023–October 2025). Treatment involved filling the catheter (volume: 1–1.5 mL) with 600,000 U/mL (1 mg/mL) of alteplase solution and leaving it for approximately 40 min. Efficacy was evaluated as follows: (1) success on the first dose, (2) success after two or three doses, or (3) no success. (1) and (2) were defined as effective.
Results
We evaluated 84 alteplase administrations in 31 patients (CVCs: 47, PICCs: 27, CVPs: 10). Success on the first dose was achieved in 55% of cases and success after two or three doses in 20% of cases, resulting in an overall efficacy rate of 75% (CVCs: 72%, PICCs: 93%, CVPs: 40%). No adverse events were observed.
Conclusions
Alteplase was generally effective for treating catheter thrombosis. However, results suggest that it is less effective in CVPs than in CVCs and PICCs, and a larger sample size is necessary for confirmation. We recommend that alteplase be approved for treating catheter thrombosis in Japan.