Use of urokinase in pediatric hematology/oncology patients

Purpose: This study was conducted to determine urokinase use practices in p ediatric hematology/oncology centers. Methods: Pediatric hematology/oncology centers were surveyed by telephone r egarding 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; 6 7 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%) c enters, adverse events (eg, fever, chills, or bleeding) after urokinase adm inistration were reported. At 83 of 91 (91%) centers, urokinase was routine ly used to clear thrombi in children with central nervous system tumors des pite contraindications. At 80 of 92 (87%) centers, occluded CVCs were repla ced after unsuccessful thrombolytic therapy, but only 21% of the centers al tered the CVC maintenance protocol after replacement. Written protocols, th e use of multiple boluses, and urokinase infusions were more likely at larg er 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 occlu ded CVCs, but protocols vary widely. Indiscriminate urokinase use can be ex pensive and potentially hazardous. Centers that use urokinase should have s tandardized protocols, monitor use and adverse effects, and periodically re view efficacy data.