Complete blalock–taussig shunt obstruction in &lt; 24 hours post‐operative period in a neonate treated emergently using transcatheter angioplasty and low dose local recombinant TPA

Patange, Amit; Blake, Jennifer; Gowda, Srinath T.

doi:10.1002/ccd.25281

Cited by 8 publications

(10 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, in these reports, relatively high doses were utilised and reflect institutional practice rather than universal guidelines. 3,4,7 Our patient responded well to local low-dose tissue plasminogen activator (0.1 mg/kg) in line with recent evidence of low-dose efficacy in small children with thrombosis. 3,7 In hindsight, high-dose heparin (330 IU/kg) administered after confirming shunt thrombosis was probably not necessary and 100 IU/kg would have been sufficient.…”

Section: Discussionsupporting

confidence: 85%

See 1 more Smart Citation

Catheter-induced acute Blalock–Taussig shunt thrombosis and bailout

2020

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 85%

“…The role of tissue plasminogen activator in shunt thrombosis has been proposed, but it is not well established. 3,4 Case report…”

mentioning

confidence: 99%

Catheter-induced acute Blalock–Taussig shunt thrombosis and bailout

2020

View full text Add to dashboard Cite

show abstract

“…Compared with other Asian ethnic groups, the Chinese and Korean populations had a higher incidence of sICH (4.6% and 8.4% respectively, vs 0-3.5%) without increased mortality. 21 The combination of low dose or standard dose of IV tPA with other treatment modalities for AIS Several studies have explored the combination of low dose or standard dose of IV tPA plus IA tPA, [22][23][24][25][26][27][28][29] including one with IA thrombectomy study 30 and two with a glycoprotein IIb/IIIa agent. 31 32 IV therapy was usually given prior to other treatments.…”

Section: Resultsmentioning

confidence: 99%

Low-dose intravenous tissue plasminogen activator for acute ischaemic stroke: an alternative or a new standard?

et al. 2016

View full text Add to dashboard Cite

BackgroundWith the recent publication of a large clinical trial on the use of a lower dose of intravenous (IV) tissue plasminogen activator (tPA) for acute ischaemic stroke (AIS), the concept of using a different dose has been debated. We intend to review the literature on using a lower dose of IV tPA and gain a better understanding of the impact of different IV doses on the treatment of patients with AIS.MethodsA comprehensive literature search of the related topics in PubMed, EMBASE, Web of Science and MEDLINE was carried out. Key words used include low dose IV tPA, thrombolysis, Alteplace and tPA for AIS. Findings were tabulated according to the size of the cohort studied, outcome, adverse event and level of evidence. The results of all studies using lower doses were analysed for efficacy and adverse events.ResultsFrom 1992 to 2016, there were 23 trials that included 10 950 patients published on the use of lower doses of IV tPA for AIS. Doses ranged from 0.5, 0.6, 0.75 to 0.85 mg/kg. Most were observational, retrospective and registry studies. One was a prospective open-label randomised controlled trial. 13 trials combined lower doses of IV tPA with a glycoprotein IIb/IIIa inhibitor or thrombectomy. Patients treated with lower doses of IV tPA showed a trend of lower rate of symptomatic intracranial haemorrhage and mortality at 3 months but slightly more disability.ConclusionsLower doses of IV tPA showed less haemorrhagic events but were not more effective compared with the standard dose. The optimal low dose of IV tPA remains unclear. Patients with AIS with a high risk of developing sypmtomatic intracranial haemorrhage might benefit from lower dose IV tPA, such as 0.6 mg/kg.

show abstract

“…In general, however, the total amount of rTPA required for a thrombolysis procedure will depend on the extent of the thrombus formation, response to the drug, coagulation status of the patient, and complications associated with the procedure. There are several case reports on the local administration of rTPA to treat thrombosis of modified Blalock-Taussig shunts [28,[35][36][37]. In these cases, resolution of the clotted grafts was achieved circulation would be limited.…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, specific practice guidelines regarding the use of CDT have been established [20][21][22]. In contrast, evidence-based recommendations for this form of therapy in infants and young children are not available, and current practice is largely based on previously reported cases [23][24][25][26][27][28]. Thus, part I of this study consisted of a review of our experience with a cohort of critically ill infants who developed complete central shunt thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Catheter-Directed Thrombolysis for Occluded Central (Ascending Aorta-to-Pulmonary Artery) Shunts: Importance of Shear Stress-Induced, Platelet-Mediated Thrombosis

Singh¹,

Sernich²,

Siwik³

et al. 2016

jshd

View full text Add to dashboard Cite

A central (ascending aorta-to-pulmonary artery) shunt is a standard palliative operation for infants with cyanotic congenital heart disease. Thrombosis of these shunts can be life-threatening. We report our experience with catheter-directed thrombolysis using recombinant tissue plasminogen activator to locally treat totally occluded central shunts as an alternative to surgery. Ten patients (median age 47 days) successfully underwent the procedure. Following thrombolysis, shunt patency was verified by angiography. The arterial oxygen (O 2 ) saturations in 100% O 2 increased from a median value of 55% to 90%. Major bleeding did not occur in any patients. Computational fluid dynamics was used to identify a relationship between shunt hemodynamics and thrombosis. We retrospectively analyzed blood flow through simulations of these shunts as they would have appeared prior to obstruction. The calculations revealed that flow negotiating "angulated" portions of these central shunts produced wall shear stresses of 157-168 Pa (or N/m 2 ), with shear rates reaching 31,400-33,600/s. These values are easily high enough to initiate platelet activation/aggregation, leading to thrombus formation. We conclude that: 1) catheter-directed thrombolysis can be used to rapidly, effectively, and safely resolve total central shunt occlusion in critically ill neonates and 2) central shunts containing prominent angulation are at risk for developing shear stress-induced, plateletmediated thrombosis. This finding is clinically important as this flow-directed process is not affected by prophylactic aspirin against shunt thrombosis.

show abstract

Complete blalock–taussig shunt obstruction in < 24 hours post‐operative period in a neonate treated emergently using transcatheter angioplasty and low dose local recombinant TPA

Cited by 8 publications

References 14 publications

Catheter-induced acute Blalock–Taussig shunt thrombosis and bailout

Catheter-induced acute Blalock–Taussig shunt thrombosis and bailout

Low-dose intravenous tissue plasminogen activator for acute ischaemic stroke: an alternative or a new standard?

Catheter-Directed Thrombolysis for Occluded Central (Ascending Aorta-to-Pulmonary Artery) Shunts: Importance of Shear Stress-Induced, Platelet-Mediated Thrombosis

Contact Info

Product

Resources

About