Recombinant tissue plasminogen activator (rt-PA) is used to restore patency and avoid inadvertent removal of peripheral and central venous catheters. rt-PA was reconstituted (1 mg/mL) then cryopreserved at ？30 °C for 1, 2, 3, 6, 8, and 12 months and, then its stability was determined. After cryopreservation for one and two months, rt-PA kept more than 95% of its activity compared to standard samples, while cryopreservation for three months caused 8% loss of activity. However, after cryopreservation for six months or more, rt-PA retained only 87.5% or less activity compared to standard samples. Therefore, it is recommended that reconstituted rt-PA be cryopreserved at ？30 °C for a maximum period of three months.
References
[1]
Todd, J.L.; Tapson, V.F. Thrombolytic Therapy for Acute Pulmonary Embolism A Critical Appraisal. Chest J. 2009, 135, 1321–1329, doi:10.1378/chest.08-2125.
[2]
Meers, C.; Toffelmire, E.B. Urokinase efficacy in the restoration of hemodialysis catheter function. J. CANNT 1998, 8, 17–19.
[3]
Weisel, J.W.; Litvinov, R.I. The Biochemical and Physical Process of Fibrinolysis and Effects of Clot Structure and Stability on the Lysis Rate. Cardiovasc. Hematol. Agents Med. Chem. 2008, 6, 161–180, doi:10.2174/187152508784871963.
Davis, S.; Vermeulen, L.; Banton, J.; Schwartz, B.; Williams, E. Activity and dosage of alteplase dilution for clearing occlusions of venous-access devices. Am. J. Health. Syst. Pharm. 2000, 57, 1039–1045.
[8]
Hemmelgarn, B.R.; Moist, L.M.; Lok, C.E.; Tonelli, M.; Manns, B.J.; Holden, R.M.; LeBlanc, M.; Faris, P.; Barre, P.; Zhang, J.; Scott-Douglas, N. Prevention of Dialysis Catheter Malfunction with Recombinant Tissue Plasminogen Activator. New Engl. J. Med. 2011, 364, 303–312, doi:10.1056/NEJMoa1011376.
[9]
Baskin, J.L.; Pui, C.-H.; Reiss, U.; Wilimas, J.A.; Metzger, M.L.; Ribeiro, R.C.; Howard, S.C. Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet 2009, 374, 159–169.
[10]
Daeihagh, P.; Jordan, J.; Chen, G.J.; Rocco, M. Efficacy of Tissue Plasminogen Activator Administration on Patency of Hemodialysis Access Catheters. Am. J. Kidney Dis. 2000, 36, 75–79, doi:10.1053/ajkd.2000.8273.
[11]
Wiernikowski, J.T.; Crowther, M.; Clase, C.M.; Ingram, A.; Andrew, M.; Chan, A.K.C. Stability and sterility of recombinant tissue plasminogen activator at -30°C. Lancet 2000, 355, 2221–2222.
[12]
Isaac, B. Efficacy of cryopreserved recombinant alteplase for declotting thrombosed central catheters. Ann. Pharmacother. 2000, 34, 533–534.
[13]
Kerner, J.A.; Garcia-Careaga, M.G.; Fisher, A.A.; Poole, R.L. Treatment of Catheter Occlusion in Pediatric Patients. J. Parenter. Enteral. Nutr. 2006, 30, S73–S81, doi:10.1177/01486071060300S1S73.
[14]
Atkinson, J.B.; Bagnall, H.A.; Gomperts, E. Investigational use of tissue plasminogen activator (t-PA) for occluded central venous catheters. J. Parenter. Enteral. Nutr. 1990, 14, 310–311.
[15]
Iqbal, Y.; Al-Katheri, A.; Al-Sedairy, R.; Al-Omari, A.; Abullah, M.F.; Crankson, S. Cryopreserved recombinant tissue plasminogen activator for the restoration of occluded central venous access devices in pediatric oncology patients. Ann. Saudi. Med. 2002, 22, 300–302.
[16]
Genentech Inc. Product Monograph Activase？ rt-PA (alteplase); Genentech, Inc.: South San Francisco, CA, USA, 2001; p. 18.
[17]
Haire, W.D.; Herbst, S.F. Consensus conference on the use of Alteplase (t-PA) for the management of thrombotic catheter dysfunction. J. Vasc. Access. 2000, 1–8.
[18]
Calis, K.A.; Cullinane, A.M.; Horne, M.K. 3rd Bioactivity of cryopreserved alteplase solutions. Am. J. Health. Syst. Pharm. 1999, 56, 2056–2057.
[19]
Shaw, G.; Sperling, M.; Meunier, J. Long-term stability of recombinant tissue plasminogen activator at -80 C. BMC Res. Notes 2009, 2, 1–3, doi:10.1186/1756-0500-2-1.
[20]
Mataga, N.; Mizuguchi, Y.; Hensch, T.K. Experience-Dependent Pruning of Dendritic Spines in Visual Cortex by Tissue Plasminogen Activator. Neuron 2004, 44, 1031–1041, doi:10.1016/j.neuron.2004.11.028.
