Treatment of neonatal thrombus formation with recombinant tissue plasminogen activator: six years experience and review of the literature
J Hartmanna, A Husseina, E Trowitzscha, J Beckerb, K-H Henneckeb
a Department of
Pediatric Cardiology, Vestische Kinderklinik, University of
Witten-Herdecke, Dr-Friedrich-Steiner- Str 5, 45711-Datteln, NRW,
Germany, b Neonatal Intensive Care Unit and Perinatal
Center
Correspondence to: Dr Hartmann, Klinik für angeborene Herzfehler, Herz- und Diabeteszentrum NRW, Universiteit Bochum, Georgstr 11, D-32545-Bad Oeynhausen, Germany jhartmann{at}hdz-nrw.de
Accepted 26 January
2001
BACKGROUND
Thrombosis
is a relatively rare event in children. However, many conditions in the
neonatal period result in an increased risk of thrombus formation. The
major risk factor is the indwelling intravascular catheter. Numerous
small studies have reported experience of thrombolytic treatment for
neonatal thrombotic disease with a wide range of different thrombolytic
agents in various forms of administration, dosage, and duration, but no
conclusions on the most effective treatment for neonates has been reached.
OBJECTIVETo assess
the efficacy and safety of thrombolytic treatment of neonatal catheter
related thrombus (CRT) formation with recombinant tissue plasminogen
activator (rt-PA).
METHODOver a six year
period, 14 neonates with CRT were treated with the same rt-PA
protocol (an initial bolus of 0.7 mg/kg over 30-60 minutes followed by
infusion of 0.2 mg/kg/h).
RESULTSComplete clot
dissolution was documented in 11 patients, and partial clot lysis in
two patients, leading to a patency rate of 94%. In two cases, local
bleeding occurred, resulting in treatment failure in one case. Finally,
antithrombin III substitution was required in one case. No other
complications such as severe bleeding were recognised.
CONCLUSIONWith the
use of close clinical and haematological monitoring on a neonatal
intensive care unit combined with serial two dimensional colour
echocardiography, the present rt-PA protocol was shown to be a safe and
effective method of clot dissolution in neonates.
Keywords: thrombus; thrombolysis; blood clot; tissue plasminogen activator
© 2001 by Archives of Disease in Childhood
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