{"id":46961,"date":"2001-01-23T00:00:00","date_gmt":"2001-01-23T06:00:00","guid":{"rendered":"https:\/\/www.unmc.edu\/newsroom\/2001\/01\/23\/unmc-researcher-finds-popular-drug-used-for-heart-attackseffective-in-dissolving-clots-that-block-catheters\/"},"modified":"2022-08-29T10:53:30","modified_gmt":"2022-08-29T15:53:30","slug":"unmc-researcher-finds-popular-drug-used-for-heart-attackseffective-in-dissolving-clots-that-block-catheters","status":"publish","type":"post","link":"https:\/\/www.unmc.edu\/newsroom\/2001\/01\/23\/unmc-researcher-finds-popular-drug-used-for-heart-attackseffective-in-dissolving-clots-that-block-catheters\/","title":{"rendered":"UNMC Researcher Finds Popular Drug Used for Heart Attacks\n\nEffective in Dissolving Clots That Block Catheters"},"content":{"rendered":"

A researcher from the University of Nebraska Medical Center has determined<\/p>\n

that a widely used drug for heart attacks is effective in restoring function<\/p>\n

in catheters blocked by blood clots, a common medical problem that occurs<\/p>\n

in about a million patients every year.<\/p>\n

William Haire, M.D., and colleagues from 25 other centers nationwide<\/p>\n

found that recombinant tissue plasminogen activator (rt-PA), also known<\/p>\n

under the trade name Activase (Alteplase, recombinant), successfully dissolves<\/p>\n

blood clots that block central venous access devices called catheters.<\/p>\n

A catheter is a thin, silicon rubber tube that is surgically inserted into<\/p>\n

large veins such as the jugular (in the neck), femoral (in the leg) or<\/p>\n

subclavian vein (in the chest).<\/p>\n

Dr. Haire will present his findings from the Cardiovascular Thrombolytic<\/p>\n

to Open Occluded Lines (COOL) study Jan. 25 at the International Symposium<\/p>\n

for Endovascular Therapy in Miami, Fla. Genentech, Inc., maker of the Activase,<\/p>\n

funded the study.<\/p>\n

The findings about the drugs effectiveness are important because surgery<\/p>\n

currently is one of the few options for restoring flow to a clot-blocked<\/p>\n

catheter. Urokinase, the only other drug used for this purpose, was withdrawn<\/p>\n

from the market in 1999, creating a major problem for patients and practitioners.<\/p>\n

About 5 million patients a year receive intravenous drug medication<\/p>\n

through catheters for conditions including cancer, intestinal disease and<\/p>\n

those who need long-term, high dose antibiotics. Catheter blockages prevent<\/p>\n

patients from getting lifesaving medications and also prevent the drawing<\/p>\n

of blood for diagnostic tests. Depending on medical needs, catheters can<\/p>\n

be worn for short periods of time or up to several years.<\/p>\n

It is estimated about 25 percent of patients will experience blocked<\/p>\n

catheters. About 60 percent of those patients have blockages that involve<\/p>\n

clots, Dr. Haire said. The other 40 percent are due to mechanical problems<\/p>\n

such as kinks in the catheter.<\/p>\n

Clots typically develop over time when fibrin, a naturally-occurring<\/p>\n

substance that promotes blood coagulation, builds up within the body, near<\/p>\n

the tip or along the catheter.<\/p>\n

Blockages prevent aggressive, livesaving treatment from being given.<\/p>\n

Without, in essence a spigot or faucet, aggressive life-saving treatments<\/p>\n

simply couldnt be given, said Dr. Haire, UNMC professor of internal medicine<\/p>\n

who specializes in hematology. Furthermore, surgery to remove a catheter<\/p>\n

and install a new one is not a favorable option, especially for very sick<\/p>\n

patients undergoing bone marrow transplants. Any surgical procedure poses<\/p>\n

a significant health risk.<\/p>\n

 <\/p>\n

It isnt practical to use the patients own veins and puncture a vein<\/p>\n

every time you need to give medication or withdraw blood for diagnostic<\/p>\n

purposes. This damages the veins to the point where there may be no usable<\/p>\n

veins in most people after a few weeks of therapy, he said.<\/p>\n

Dr. Haire, who specializes in blot clots as well as catheter complications,<\/p>\n

has published 30 articles on the subjects over the last 15 years, including<\/p>\n

two in the New England Journal of Medicine and the Journal of the American<\/p>\n

Medical Association.<\/p>\n

The six-month COOL study was completed in May 2000. A total of 150 patients<\/p>\n

with blocked catheters were enrolled in the randomized, double-blind study<\/p>\n

to find out if Alteplase was effective in restoring function to catheters<\/p>\n

blocked by clots.<\/p>\n

Patients were separated into two groups. For ethical reasons, the study<\/p>\n

was designed so all patients ultimately would receive Alteplase for their<\/p>\n

blocked catheter.<\/p>\n

In the control group, patients were given one dose of placebo a saline<\/p>\n

solution — in their catheter. If catheter function was not restored, patients<\/p>\n

then received one, 2 milligram dose of Alteplase. If catheter function<\/p>\n

was not restored, patients then received a second dose. In this group,<\/p>\n

researchers found 17.1 percent of the patients had their catheters working<\/p>\n

after the placebo. But after one or two doses of drug, catheter function<\/p>\n

was restored in 90 percent of patients.<\/p>\n

We think the placebo worked in 17 percent of patients because the catheter<\/p>\n

tip may have become kinked inside the vessel and it just straightened out<\/p>\n

on its own. Or perhaps it was because we were injecting something, Dr.<\/p>\n

Haire said.<\/p>\n

In the other control group, patients first received a 2 milligram dose<\/p>\n

of Alteplase, followed by another dose if the catheter remained blocked.<\/p>\n

In this group, researchers found after just one dose of the drug, 73.9<\/p>\n

percent of the patients catheters worked. Those who still had blockage<\/p>\n

were given a second dose, restoring catheter function to 90 percent.<\/p>\n

No serious drug-related adverse events were observed as a result of<\/p>\n

treatment and there were no cases of intracranial hemorrhage, embolism<\/p>\n

or serious drug-related reactions.<\/p>\n

While a few patients who first received the placebo in this study did<\/p>\n

have their catheters cleared, many more patients achieved full catheter<\/p>\n

function with Alteplase, demonstrating the drug is vastly superior to placebo,<\/p>\n

Dr. Haire said.<\/p>\n

The importance of finding ways to dissolve clots caused by catheter<\/p>\n

placement became evident when catheters came into widespread medical use<\/p>\n

in the late 1970s and early 1980s. A variety of therapies were beginning<\/p>\n

to be used for treatment of various types of cancers that all required<\/p>\n

medications, transfusions and frequent blood draws, for treatments lasting<\/p>\n

several weeks or months.<\/p>\n

Dr. Haire has been working with Genentech since 1993 to conduct research<\/p>\n

on Alteplases effectiveness in clearing clot-obstructed catheters. Based<\/p>\n

on the COOL effectiveness study, another study has been conducted in 1,000<\/p>\n

patients to determine the safety of the drug. Those results are expected<\/p>\n

soon, Dr. Haire said.<\/p>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"

A researcher from the University of Nebraska Medical Center has determined that a widely used drug for heart attacks is effective in restoring function in catheters blocked by blood clots, a common medical problem that occurs in about a million patients every year. William Haire, M.D., and colleagues from 25 other centers nationwide found that […]<\/p>\n","protected":false},"author":79,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-46961","post","type-post","status-publish","format-standard","hentry","category-uncategorized","department-press-release"],"yoast_head":"\nUNMC Researcher Finds Popular Drug Used for Heart Attacks Effective in Dissolving Clots That Block Catheters<\/title>\n<meta name=\"description\" content=\"A 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