Dialysis graft declotting with very low dose urokinase: Is it feasible to use "less and wait?"

PURPOSE: "Lyse and wait" dialysis graft declotting is simple and effective, but the minimum necessary dose of urokinase is unknown, The efficacy of th e technique with very low dose urokinase is evaluated. MATERIALS AND METHODS: Twenty-one grafts in 17 patients were declotted with use of the lyse and wait technique, but with 5,000-15,000 U of urokinase i nitially. Graft angiography was performed when an interventional suite was available. Declotting was completed in the manner chosen by the individual operator. Angiograms, interventional radiology records, and dialysis record s were reviewed. RESULTS: Technical and clinical success were achieved in 95% of cases. Mean initial urokinase dose was 6,667 U, Initial angiography was performed at a mean 86 minutes. Two cases required second 5,000-U boluses to achieve comp lete graft thrombolysis. In all other cases, complete or near complete graf t thrombolysis was observed with the initial very low dose. No bleeding, ar terial embolic, or pulmonary embolic complications were observed. CONCLUSIONS: Doses of urokinase as low as 5,000 U are effective for lyse an d wait declotting. A substantial reduction in drug costs can be expected wi th the "less and wait" modification, Bleeding risk may also be reduced.