Literature review (Medline) on recombinant tissue plasminogen activator (rt-PA) treatment in neonatal period
| Author | No of patients | rt-PA dose | Clot outcome | Complications/side effects | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bolus (mg/kg) | Infusion (mg/kg/h) | Duration (h) | ||||||||||
| Small series | ||||||||||||
| Anderson13 | 4 | None | 0.05 | 96–240 | Complete 3 | IVH, rethrombosis | ||||||
| Dillon14 | 3 | 0.5 | 0.04–0.08 | 58 | Complete | Local bleeding | ||||||
| Nowak-Göttl12 16 42 3-150 | 19 | 0.1–0.75 | 0.03–0.375 | 0.5–240 | Complete 15 | Rethrombosis, local and significant bleeding, IVH | ||||||
| Partial 3 | ||||||||||||
| Farnoux15 3-151 | 16 | 0.1 | 0.3 | 3 | Complete 7 | 1 deadly bleeding | ||||||
| Partial 7 | ||||||||||||
| Weiner17 | 7 | None | 0.1–0.5 | 6–39 | Complete 4 | Severe bleeding | ||||||
| Partial 2 | ||||||||||||
| Single cases | ||||||||||||
| Zenz | 2 | 0.1–0.5 | 0.25 | 4–9 | Complete 1 | Local and renal bleeding | ||||||
| Partial 1 | ||||||||||||
| Trowitzsch | 1 | 0.3 | 0.2 | 7 | Complete | None | ||||||
| Kennedy | 1 | None | 0.47 | 3 | Complete | Amputation of toes | ||||||
| Levy3-152 | 2 | None | 0.47 | 2–72 | Complete | Local bleeding | ||||||
| Deeg | 1 | None | 0.5 | 3 | Partial | IVH extension | ||||||
| Van Overmeire | 1 | 0.5 | 0.2 | 48 | Complete | None | ||||||
| Schneider | 1 | 0.1 | 0.2 | 6 | Complete | None | ||||||
| Guerin | 2 | None | 0.05–0.2 | 12–24 | Complete | None | ||||||
| Berger | 2 | 0.1 | 0.3 | 3 | Complete | None | ||||||
| Ries3-153 | 1 | 0.1–0.2 | 0.03–0.06 | 34 | Complete | None | ||||||
| Thul3-154 | 1 | 0.2 | 0.4 | 2 | Complete | Bleeding | ||||||
| Ahluwalia | 1 | None | 0.5 | 10 | Complete | None | ||||||
| Smets | 2 | None | 0.1–0.4 | 48–264 | Partial | Significant bleeding | ||||||
| Seibold-Weiger | 1 | None | 0.08 | 12 | No lysis | Extensive bleeding | ||||||
| Kandler | 1 | 0.4 | 0.02 | 36 | Complete | None | ||||||
| Daoud | 1 | 0.1 | 0.3 | 3 | Complete | None | ||||||
| Torkington3-160 | 1 | 0.15 | 0.3–0.75 | 3 | Complete | NEC | ||||||
| Giuffre | 2 | None / 1 | 0.5–1 | 4–6 | Complete | None | ||||||
| Grieg | 1 | None | 1 | 15 | Complete | None | ||||||
| Di Bernado | 1 | 0.3 | 0.3 | 16 | Partial | IVH, bleeding | ||||||
| Krienke | 2 | 0.3–0.5 | 0.02–0.04 | 8–64 | Complete 1 | None | ||||||
| Partial 1 | ||||||||||||
| Glover | 1 | 0.48 | 0.27 | 6 | Complete | IVH | ||||||
| Klinge†† | 1 | 0.01 | None | — | Partial | Vascular spasm | ||||||
| Malm | 1 | 0.05 | None | — | Complete | IVH | ||||||
| ∑ | 80 | 0–0.75 | 0.02–1 | ½–264 | Complete 55 | Local to severe bleeding, rethrombosis, amputation, vascular spasm | ||||||
| Partial 20 | ||||||||||||
| Own collection | 14 | 0.7 | (0.1–) 0.2 (–0.3) | 24–120 | Complete 11 | Local bleeding | ||||||
| Partial 2 | ||||||||||||
Only data of reports with complete information were included. Requests for entire literature list of single cases tojhartmann{at}hdz-nrw.de. The bolus was a short infusion (10–60 minutes).
↵3-150 Data collection was performed as a meta-analysis of all reports;
↵3-151 up to four additional rt-PA infusions were given at intervals of 12–24 hours;
↵3-152 only data of neonates were reviewed;
↵3-153 bolus infusion was repeated twice with 0.1 mg/kg and twice with 0.2 mg/kg followed by continuous infusion of 0.06 mg/kg/h for 16 hours and 0.03 mg/kg/h for 18 hours;
↵3-154 regimen was repeated after 12 hours;
↵3-160 1.5 mg/kg once a day, 10% as bolus, 50% as infusion over one hour and 40% as infusion over two hours, repeated on six days;†† bolus dose was repeated 3 times.
IVH, Intraventricular haemorrhage; NEC, necrotising enterocolitis.