Lack of efficacy of twice-weekly urokinase in the prevention of complications associated with Hickman catheters: a multicentre randomised comparison of urokinase versus heparin

Hickman catheters (HC) are associated with complications, in particular inf ection, occlusion and thrombosis. We tested the hypothesis that regular flu shing of catheters with urokinase would reduce the frequency of these compl ications. Patients who required a double-lumen HC for (1) bone marrow or pe ripheral blood progenitor cell transplantation or (2) intensive combination chemotherapy for haematological malignancies were randomised to receive tw ice-weekly flushes of either urokinase (5000 units) or heparin (50 units). HC-survival analysis was determined by Cox regression. 100 patients were en rolled (urokinase = 52; heparin = 48) and treated for a mean of 8.5 weeks. No significant difference was observed in the incidence of HC-associated se pticaemic events, which occurred in 8/52 in the urokinase group and 9/48 in the heparin group (actuarial incidence 20% versus 25%, P = 0.50). Similarl y, there was no differences in the incidence of exit site infections (uroki nase = 27/52 and heparin = 28/48, P = 0.122); HC-septic thromboses (urokina se = 2/52 and heparin = 4/48, P = 0.34); lumen occlusion (urokinase = 30/52 and heparin = 30/48, P = 0.681); or venous thrombosis (urokinase = 8/52 an d heparin = 6/48, P = 0.726). Overall, a high incidence of HC-related compl ications was seen in both groups; 40/52 in the urokinase group and 40/48 in the heparin group (actuarial incidence 80% versus 90%, P = 0.367). Despite this only 18% of HC required early removal due to complications (urokinase = 8, heparin = 10). There was no difference in the incidence of complicati ons in patients undergoing transplantation (n = 68) compared with chemother apy alone (n = 32). Patients with haematological malignancies were more lik ely to have HC-related infective complications (P = 0.006), and patients wi th solid tumours more likely to have venous thrombosis (P = 0.027). The cum ulative incidence of HC-related complications in this prospective study was higher than in previously reported series. Urokinase did not appear effect ive in reducing the frequency of these complications. (C) 2001 Elsevier Sci ence Ltd. All rights reserved.