The role of fibrinolytic agents in the management of thrombotic complications associated with vascular access devices.

VADs have made a significant contribution to improving quality of life for patients requiring long-term therapies. Clearly, this means of vascular access has offered relief from repeated venipuncture for IV access or blood sampling. Reports of the incidence of associated noninfectious complications vary between 14% and 25%. These rates are significant and warrant the development of strategies to manage such events. Fibrinolytic therapy offers a viable option for patients who have developed complications of a thrombotic nature. Although direct IV push administration may be relatively well accepted, many questions remain regarding the delivery of continuous infusions. Questions about dosing regimens, timing and number of administrations, and the ideal route of delivery all provide fertile opportunities for collaborative research.