Pentoxifylline in the treatment of neonatal vasospasm and thromboembolism: An observational case series study

Abstract

What is known and objective Newborns, particularly preterm babies, are prone to vascular vasospasm and thromboembolism. Differences in the haemostatic system, small vessel diameter and presence of any serious diseases are predisposing causes of thromboembolic disease in newborns. The lack of randomized controlled studies on the management of vasospasm and thromboembolism exacerbates the problem. We present a case series of the successful and safe use of PTX for the treatment of vasospasm and thrombosis in neonates. Methods The study was conducted in the Bezmialem Vakif University Hospital Neonatal Intensive Care Unit (NICU). A retrospective chart review was performed on consecutive patients treated for vascular spasm and thrombosis. Nine patients diagnosed with vasospasm or thrombosis were enrolled in the study. Results Five patients had arterial injuries. Six patients were premature, and five patients were diagnosed with thrombosis by using Doppler ultrasonography (US). The drug was diluted with 5% dextrose and administered intravenously at a dose of 5 mg/kg/h over six hours, ranging from 1 to 5 days. No drug‐related side effects were observed. All babies recovered, and no amputation was performed. What is new and conclusion PTX may be an alternative treatment for vascular vasospasm and thromboembolism with fewer side effects than anticoagulant and thrombolytic agents in neonates. Starting PTX in the early stages of vascular insult may prevent the development of vasospasm and thromboembolism and thus limb ischaemia.

Management of penile post-circumcision ischemia by pentoxifylline infusion and hyperbaric oxygen therapy

“…HBOT controls the infection and promotes healing, it also potentiates tissue oxygenation by improving angiogenesis via the stimulation of mediators like hypoxia-induced factors and vascular endothelial growth factors and also increasing collagen matrix formation [ 8 & 9 ]. It induces the proliferation of fibroblasts by increasing the production of fibroblast growth factor and Transforming Growth Factor [ 11 ]. It has a direct toxic effect on anaerobic bacteria by enhancing the production of oxygen free radicals, which oxidize proteins and membrane lipids, destroy DNA, and decrease bacterial metabolism.…”

“…All those modalities of treatment have either a limited success rate or were applied for a limited number of cases [ 8 ]; however, there is no currently available study about the treatment of choice [ 10 ]. Based on our basic information about HBOT and pentoxifylline as potent vasodilators and other agents that increase erythrocyte flexibility, reduce blood viscosity, and increase microcirculatory flow and tissue perfusion [ 11 ], we came up with a protocol for the management of children with post-circumcision penile ischemia by improving tissue revascularization, oxygenation, and infection control. HBOT in children means inhalation of 100% oxygen at pressures of up to 760 mmHg, which is used to increase the amount of oxygen dissolved in plasma from 3 mL/L at sea level to 60 mL/L, which is the concentration required for normal tissue perfusion [ 10 ].…”

“…HBOT in children means inhalation of 100% oxygen at pressures of up to 760 mmHg, which is used to increase the amount of oxygen dissolved in plasma from 3 mL/L at sea level to 60 mL/L, which is the concentration required for normal tissue perfusion [ 10 ]. Also this level of plasma oxygen can reach the obstructed areas of resting ischemic tissues, where red blood cells (RBCs) cannot reach and without the need for oxygen carried by the hemoglobin [ 10 , 11 ].…”

The effect of pentoxifylline and different types of exercise training on coagulation factors in a rat endometriosis model

“…Additionally, PTX has antiplatelet and antithrombotic effects 17 , 18 , 19 . In any case, there are some contradictions considering the impact of PTX on endometriosis [20] .…”

Management of Penile Post-circumcision Ischemia by Pentoxifylline Infusion and Hyperbaric Oxygen Therapy

“…5 In the literature, a different methods and pharmacologic agents have been reported for the management of penile ischemia; however, there is no currently available study about the treatment of choice. 2,8−13 Based on our basic information about HBOT and pentoxifylline as potent vasodilators and other agents that increase erythrocyte exibility, reduce blood viscosity, and increase microcirculatory ow and tissue perfusion 14 , we came up with a protocol for the management of children with post-circumcision penile ischemia by improving tissue vascularization, oxygenation, and infection control. HBOT in children means inhalation of 100% oxygen at pressures of up to 760 mmHg, which is used to increase the amount of oxygen dissolved in plasma from 3 mL/L at sea level to 60 mL/L, which is the concentration required for normal tissue perfusion.…”