Intrauterine Upper Extremity Thrombosis Successfully Treated with Recombinant Tissue Plasminogen Activator, Enoxaparin and Collagenase

Abstract

Intrauterine ischemia of the limbs is a rare condition involving thrombosis and ischemia of the extremities before birth. The clinical presentation depends on the extremity affected as well as the timing of thrombosis. Very few cases with extremity hypoperfusion and gangrene due to intrauterine thrombosis have been reported in the literature, and therefore there is no consensus on the optimal therapeutic strategy for such cases. Presented here is a case of a newborn with intrauterine brachial arterial thrombosis of the right upper extremity who was successfully treated by a combination of recombinant tissue plasminogen activator, enoxaparin and collagenase application followed by surgery.

A novel role for milrinone in neonatal acute limb ischaemia: successful conservative treatment of thrombotic arterial occlusion without thrombolysis

“…Early recognition and prompt treatment of perinatal NLI is essential to the preservation of limb function 8 9. Systemic anticoagulation,8 thrombolysis with tissue plasminogen activator, either systemic or catheter-directed,1 2 8 peripheral nerve blockade,10 caudal blockade10 and surgical thrombectomy1 have all been proposed as suitable management options. Low rates of revascularisation and significant perioperative mortality have been reported in infants undergoing surgical management,11 which is technically challenging due to neonates’ small, friable vessels.…”

Intrauterine Upper Limb Ischemia: An Unusual Presentation of Fetal Thrombophilia—A Case Report and Review of the Literature

“…However, early diagnosis and prompt management are the essential parts for preserving limb function and perfusion as some cases were associated with a favorable outcome [3, 20, 22, 26]. There are no large trials comparing different therapeutic regimens [7, 52], making the decision highly individualized and based on clinical picture. …”