OBJECTIVE: To review the literature pertaining to the efficacy of alteplase for 
restoration of patency of occluded venous and dialysis catheters in pediatric 
patients.
DATA SOURCES: A MEDLINE search was conducted and cross-referenced with an EMBASE 
search through November 2012. Search terms included alteplase, tissue 
plasminogen activator, and catheter.
STUDY SELECTION AND DATA EXTRACTION: Search results were limited to humans, 
English language, and ages from neonates to 18 years. Pertinent studies 
discussing efficacy of alteplase for restoration of occluded venous or dialysis 
catheter function were included. Case reports, review articles, and studies that 
specified inclusion of hemophilia patients or more than 75% of children with 
malignancy were excluded.
DATA SYNTHESIS: Fibrinolytics are the drug class of choice for restoration of 
patency (defined as the ability to withdraw a blood sample) of thrombus-occluded 
catheters. The trials used to support Food and Drug Administration approval of 
alteplase for central venous catheter (CVC) occlusions generally had low 
pediatric enrollment; however, additional small studies are available that 
support use of alteplase for this indication in children. Alteplase doses of 
0.5-2 mg instilled into the lumen of a CVC with dwell times ranging from 30 to 
more than 240 minutes plus the potential for repeat dosing were reported. 
Overall efficacy ranged from approximately 50% to 90%, with greater efficacy 
generally reported with larger doses and longer dwell times. Alteplase doses of 
2-2.5 mg with dwell times of 60-120 minutes were observed in 2 studies of 
occluded peritoneal or hemodialysis catheters, in which efficacy was reported in 
57-100% of cases. Limitations of current studies of alteplase for catheter 
occlusion in children include small study populations and relative lack of 
pediatric-specific prospective trials.
CONCLUSIONS: Alteplase appears to show efficacy for treatment of 
thrombus-related venous catheter occlusion in pediatric patients; however, data 
regarding its use in occluded dialysis catheters are limited.