Post-operative intracranial hemorrhage related to using t-PA for declotting an occluded hemodialysis catheter: A cautionary tale.

Heparin and thrombolytic agents such as tissue plasminogen activator (t-PA) are frequently used to prevent and treat occluded hemodialysis (HD) catheters. Thrombolytic agents have not been well studied for systemic effects. We present a post-operative neurosurgical patient who experienced a symptomatic intracranial hemorrhage (ICH) after t-PA was used to treat an occluded HD catheter. This case highlights that using t-PA to treat dysfunctional catheters may be associated with ICH in neurosurgical patients. Management strategies are discussed with a review of pertinent literature.