MO034A RANDOMISED CONTROLLED TRIAL OF TAUROLIDINE CITRATE VERSUS TAUROLIDINE UROKINASE LOCK TO PREVENT TUNNELLED CATHETER THROMBOSIS IN HEMODIALYSIS PATIENTS

Abstract

Introduction and Aims: The prevalence of tunneled catheters is still high and is one of the leading causes of morbidity and mortality among dialysis patients. Catheter malfunction due to thrombosis is considered as the most frequent encountered complication and is responsible for about two thirds of ultimate catheter removal among tunneled catheter patients. Recombinant tissue plasminogen activator (rt‐PA) is efficient treatment to restore the patency of clotted catheter with high safety margin. Taurolidine Citrate with Heparin (Taurolock/Hep) is a promising catheter lock to decrease infection. We are presenting a trial to compare Taurolock/Hep to Taurolidine citrate with Urokinase (Taurolock/U) in regard to preventing catheter thrombosis. Methods: This is a prospective randomized controlled trial, in which all patients who were undergoing ambulatory tunneled catheter regular hemodialysis in Qatar were included. All patients were randomized to receive Taurolock/Hep or Taurolock/U on 1:1 basis using computer‐generated program. Patients were followed for 6 months. Episodes of acute catheter thrombosis, recurrent thrombosis, time to first episode of catheter thrombosis that led to catheter exchange, requirement for rt‐PA treatments or catheter lock per unit protocol and any bleeding or reported adverse events were collected. Results: One hundred seventy‐seven patients participated, 30 patients did not complete the study (fistula cannulation, death and transferring to peritoneal dialysis) but were included in the final analysis. 93 Patients in Taurolock/Hep and 84 in the Taurolock/U. Age, sex, catheter age, blood flow rates and venous pressures before study, use of antiplatelet or warfarin and co‐morbidities did not differ between the two groups. Three catheters were removed in Taurolock/Hep group due to acute thrombosis with mean time to removal of 79 days and length of stay in hospital 9 days. No catheters were removed in Taurolock/U group. Table below summarize comparison of need to use rt‐PA during trial. There were no reported serious adverse events reported during study. Repeated use of rt‐PA as catheter lock for catheter malfunction was significantly lower in Taurolock/U group than Taurolock/Hep group (p Value 0.03). Repeated use of rt‐PA as a catheter lock or treatment for catheter malfunction also was significantly lower in Taurolock/U versus Taurolock/Hep (p Value 0.006). Conclusions: In a comparison trial between Taurolock/U and Taurolock/Hep, we found significant decrease in the number of acute thrombosis episodes requiring catheter removal, less need for rt‐PA for catheter malfunction in the Taurolock/U group. This is the first study to provide such comparison and carries great prospect regarding cost saving with hospital admission, rt‐PA use and maintaining vascular access. (Table Presented).