Use of urokinase in pediatric hematology/oncology patients

Purpose: This study was conducted to determine urokinase use practices in pediatric hematology/oncology centers. Methods: Pediatric hematology/oncology centers were surveyed by telephone regarding urokinase use in children with central venous catheters (CVCs). Results: A total of 92 centers participated in the study. Urokinase is the primary thrombolytic agent used in pediatric hematology/oncology centers; 67 of 92 (73%) centers had a written protocol for its use. Multiple boluses of urokinase were used in most centers; only 16 of 92 (17%) centers limited urokinase use to 1 bolus per episode of CVC occlusion. At 10 of 92 (11%) centers, adverse events (eg, fever, chills, or bleeding) after urokinase administration were reported. At 83 of 91 (91%) centers, urokinase was routinely used to clear thrombi in children with central nervous system tumors despite contraindications. At 80 of 92 (87%) centers, occluded CVCs were replaced after unsuccessful thrombolytic therapy, but only 21% of the centers altered the CVC maintenance protocol after replacement. Written protocols, the use of multiple boluses, and urokinase infusions were more likely at larger centers (ie, >200 patients) than in medium (100-200 patients) or small (<100 patients) centers. Conclusions: Urokinase is a widely used alternative to replacement of occluded CVCs, but protocols vary widely. Indiscriminate urokinase use can be expensive and potentially hazardous. Centers that use urokinase should have standardized protocols, monitor use and adverse effects, and periodically review efficacy data.