Thrombolytic Therapy in Children- Clinical Experiences with Recombinant Tissue-Plasminogen Activator

Abstract

For the improvement of thrombolytic therapy with recombinant tissue-plasminogen activator (rt-PA) in children, more clinical data are needed. We retrospectively analyzed the clinical course of 20 patients (age ranging from 1 day to 16 years) with venous thrombosis (n = 16), arterial thrombosis (n = 2), and purpura fulminans by meningococcosis (n = 2). The venous thromboses were localized in the iliac-femoral veins (n = 9), brachiocephalic-jugular-subclavian veins (n = 6), and the superior caval vein (n = 1). The arterial occlusions were localized in the abdominal aorta and in the left pulmonary artery. Central venous catheters were of pathogenetic importance in seven cases. The patients were treated with rt-PA for 3 hours to 13 days. The dose ranged between 0.2 and 0.5 mg/kg for the initial bolus and 1.0 to 2.0 mg/kg/d for the continuous infusion. Nineteen patients received simultaneously low-dose unfractionated heparin. Complete clot lysis was detected in 11 cases, a partial lysis in 1, and in 8 patients thrombolytic therapy was not successful. An episode of hematemesis in one patient represented the only serious side effect observed in our study. A systemic decrease in fibrinogen concentration was also rare. In conclusion, thrombolysis with rt-PA represents an effective and safe therapy for children at the dosage used.

Acute neonatal arterial occlusion: is thrombolysis safe and effective?

“…The use of t-PA in adult practice for the treatment of pulmonary embolism, deep vein thrombosis, and acute myocardial infarction has been extensively reported. However, information regarding its use in childhood and infancy is limited [14] and most reports group arterial and venous thrombosis in a diverse age range together [15]. Regimens in use for children have, in the main, been extrapolated from adult data [16].…”

Pulmonary Embolism in Pediatrics

“…Two retrospective case series of children with arterial and venous thrombosis studied the efficacy of thrombolysis with tissue plasminogen activator in terms of clot resolution. They showed complete clot resolution in 55-65% of children, partial resolution in 5-20%, and no effect in 15-40% (84,85). Thrombolytic agents are used commonly for arterial thrombosis in children, and to unblock central venous lines (57).…”

A case of neonatal arterial thrombosis mimicking interrupted aortic arch

“…In medical treatment, heparin or fibrinolytic agents are used. Knöfler et al (16) reported that fibrinolytic t-PA was efficient and safe when used at an appropriate dose in the treatment of thrombosis. Surgical treatment is performed successfully in organized and calcified partial arcus aorta thrombosis without harming the other vessels.…”