Prevention of catheter thrombosis according to current recommendations and reimbursement policy

Abstract

The main problems associated with the use of dialysis catheters, both uncuffed and cuffed ones, arethrombotic complications, that significantly shorten their use. Venous thrombosis due to catheterization, may lead to further complications, including pulmonary embolism, posthrombotic syndrome, vascular stenosis and infection. Catheter-related complications, shortened use of catheter and the need of its replacement, significantly increase the costs to the health care system and are associated with increased mortality in patients on dialysis, which is about 1.32 times higher than in those with arteriovenous fistula. Prevention of vascular accessthrombosis in patients undergoing hemodialysis is based on catheter locking solutions as well assystemic administrated drugs. Standard clinical practice to prevent catheter clotting between dialysis session, is the use of lock solution with unfractionized heparin, citrate or taurolidine. An interesting alternative to the standard antithrombotic therapy isthe use of thrombolytic agents. Systemic therapy with oral anticoagulants is recommended in patients with recurrent thrombotic events in secondary prevention only. Whereas, the use of low molecular weight heparins is not based on the evidence-based medicine data. Therefore, the purpose of this article is to take on the problem of catheter thrombosis in relation to the current recommendations and reimbursement policy.