Tissue plasminogen activator for neonatal coronary thrombosis presenting with mitral valve regurgitation and impaired ventricular function

Abstract

Thrombolytic therapy with this tPA protocol may be safe and effective in treating neonates with coronary thrombosis.

Intracoronary recombinant tissue plasminogen activator in an infant with hypoplastic left heart syndrome and complete left main coronary artery thrombosis

“…In addition, some patients were on intravenous rTPA either before or after the intracoronary treatment. [10][11][12][13][14][15] Our patient was heparinized for ECMO, but child with HLHS. 6 The child was initially treated with 24 hr intravenous rTPA, which failed to achieve improvement.…”

“…However, in these reports, the doses were divided into 1–3 doses. In addition, some patients were on intravenous rTPA either before or after the intracoronary treatment . Our patient was heparinized for ECMO, but due to the risk of bleeding in light of open chest and being on ECMO, rTPA was only administered locally and not systemically.…”

Management of Myocardial Infarction in Children with Giant Coronary Artery Aneurysms after Kawasaki Disease

“…Pediatric dosing for a low-dose tPA protocol is 0.03-0.10 mg/kg/h IV for 6-12 hours, with a maximum dose of 2 mg/h. 18,19 Fibrinogen must be >150 mg/ dL to avoid bleeding complications. If fibrinogen is <150 mg/dL, give fresh frozen plasma 10-20 mg/kg IV and recheck.…”

“…The expected time to the catheterization laboratory of >90 minutes and PCI will be possible based on patient size and catheterization laboratory staffing: While awaiting transfer to catheterization laboratory, start tPA: Pediatric dosing for a low-dose tPA protocol is 0.03-0.10 mg/kg/h IV for 6-12 hours with a maximum dose of 2 mg/h. 18,19 Fibrinogen must be >150 mg/dL to avoid bleeding complications. If fibrinogen is <150 mg/dL, give fresh frozen plasma 10-20 mg/kg IV and recheck.…”

Newborn With Severely Depressed Left Ventricular Function

“…Earlier studies have reviewed the important role of hemodynamic stabilization with ECMO and association with long-term survival ( 5 , 6 ). In recent years, successful use of selective intra-coronary injection of recombinant tissue plasminogen activator has been described ( 7 , 8 , 9 ).…”