Extended deep vein and inferior vena cava thrombosis in a 15-year-old boy: Successful lysis with recombinant tissue-type plasminogen activator 2 weeks after onset of symptoms

Abstract

We present the case of a 15-year-old boy with thrombosis of the inferior vena cava, the femoral, inguinal, and renal veins of unknown origin. Although the thrombosis was 2 weeks old, thrombolytic therapy with recombinant tissue-type plasminogen activator (maximum dosage: 0.4 mg/kg/h) was started as this appeared to be the only change to re-establish normal kidney function. After 1 week, treatment was discontinued because of generalized bleeding. At this time, the infrarenal inferior vena cava was again patent with complete lysis of all other clots. Phlebography 3 months after lysis documented an abnormal renal vein, a tubular, subhepatical stenosis of the inferior vena cava and a large collateral vessel between the inferior vena cava and the azygos vein.

Correlation between the expression of IL‑18 and deep venous thrombosis

“…The increased expression of P-selectin can lead to the occurrence of thrombophilia, inducing the activation of procoagulants and formation of fibrin ( 22 , 23 ). Studies ( 7 , 24 ) have revealed that P-selectin has a significant effect on thrombosis, where the upregulation of soluble P-selectin in the blood can be used as a clinical risk factor in venous thrombosis. Treatment of the HUVECs with IL-18 significantly increased the expression of P-selectin, unlike vWF, and its abnormal expression was effectively suppressed following inhibition of the activation of NF-κB.…”

“…The t-PA can activate the plasminogen present on the fibrin surface, having a fibrinolytic effect locally ( 25 ). Recombinant t-PA synthesized by genetic engineering has been used as an antithrombotic drug ( 24 ). In the present study, it was found that IL-18 led HUVECs to produce t-PA, which significantly improved following the application of inhibitors of NF-κB activation.…”

Thrombolysis in Central Splanchnic Thrombosis

“…Although thrombolysis is a treatment option for mesenteric venous thrombosis, it is not yet widely used: only a few case reports have been published (Table 1) [19–30] demonstrating a wide variety of strategies. Two recent review articles on mesenteric venous thrombosis fail to mention thrombolysis as a therapeutic option [6,7].…”