Successful treatment of neonatal arterial thromboses with recombinant tissue plasminogen activator☆,☆☆,★
Section snippets
r-TPA Protocol
From 1993 to 1995 neonates with arterial thromboses were treated with r-TPA (Activase, Genentech, San Francisco, Calif.) if they were less than 44 weeks postconceptional age and had a newly diagnosed arterial thrombosis with evidence of distal tissue compromise. Thromboses were diagnosed by clinical examination and confirmed by spectral and color flow Doppler sonography (7.5 Mhz linear array transducer, Acuson, Mountain View, Calif.). Consent for therapy was obtained. Pretreatment studies
Results
Table I summarizes the results of r-TPA treatment in seven neonates who had arterial thromboses at the University of Michigan from 1993 to 1995.Patient no. Age (days) Gestation (wk) Weight (gm) Dose (mg/kg/hr)* Duration (hr) Delivery/presentation Site of thrombus Risk factors Concurrent diagnoses Complications Outcome 1 4 38 2589 0.5 26 VD/vertex Aorta, left atrium None Multifocal encephalomalacia Grade II IVH, support withdrawn F 2 1 38 3289 0.3† 24 CS/vertex Axillary artery
Discussion
Our results and the literature review suggest that r-TPA will facilitate lysis of most arterial thromboses in neonates but can be associated with both minor and major hemorrhagic complications. Our protocol for r-TPA now includes the following guidelines: (1) exclude patients with preexisting intraventricular hemorrhage or cerebral ischemic changes, (2) perform baseline laboratory assessments and cranial sonography, (3) correct hypertension before initiating r-TPA, (4) limit the r-TPA infusion
References (16)
- et al.
Successful treatment of neonatal aortic thrombosis with tissue plasminogen activator
J Pediatr
(1990) - et al.
Tissue plasminogen activator for the treatment of thromboembolism in infants and children
J Pediatr
(1991) - et al.
Recombinant tissue plasminogen activator for neonatal and pediatric vascular thrombolytic therapy
J Pediatr Surg
(1993) Normal hemostasis in the fetus and newborn: coagulation
Neonatal thrombosis and the thrombolytic system: pathophysiology and therapy
Am J Pediatr Hematol Oncol
(1988)- et al.
Management of major thromboembolic complications of umbilical artery catheters
J Pediatr Surg
(1981) - et al.
Serious complications after umbilical artery catheterization for neonatal monitoring
Arch Surg
(1975) - et al.
Diagnosis and treatment of venous thromboembolism in children and adolescents. On behalf of the Subcommittee on Perinatal Haemostasis of the Scientific and Standardization Committee of the ISTH
Thrombos Haemost
(1995)
Cited by (56)
Editor's Choice – European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia
2020, European Journal of Vascular and Endovascular SurgeryResults of nonoperative management of acute limb ischemia in infants
2018, Journal of Vascular SurgeryAortic mass in a newborn infant with respiratory distress
2017, Journal of Pediatric Surgery Case ReportsTissue Plasminogen Activator Use in Children: Bleeding Complications and Thrombus Resolution
2016, Journal of PediatricsCitation Excerpt :Our data indicate that even at equivalent tPA doses, the cardiac cohort remains at higher risk of bleeding complications. Certainly the age and size of the cardiac cohort may play a role in their sensitivity to tPA.20-24 We also noted that the cardiac patients were more critically ill, as is seen in their high rates of ventilator and inotrope dependency during tPA infusion.
Successful use of recombinant tissue plasminogen activator (r-TPA) for management of chylothorax associated with central venous thrombosis after neonatal cardiac surgery
2015, Egyptian Heart JournalCitation Excerpt :High doses of rTPA can increase rates of serious bleeding complications in children,33 but this risk should decrease with lower rTPA doses.20 Weiner et al.19 used an initial dose of 0.1 mg/kg/h of r-TPA for 6 h that was increased by 0.1 mg/kg/h at 6-h intervals to a maximum of 0.5 mg/kg/h. Two out of seven patients (1 term and 1 small preterm neonate) died at the highest infusion rate of 0.5 mg/kg/h due to severe bleeding complications. Wang et al.20 reported thrombolysis with a low-dose regimen (0.01–0.06 mg/kg/h).
Successful treatment of arterial thrombus in an extremely low-birth-weight preterm neonate
2013, Pediatrics and Neonatology
- ☆
From the Divisions of Neonatal-Perinatal Medicine and Hematology-Oncology, Departments of Pediatrics and Radiology, University of Michigan Medical School, Ann Arbor, Michigan.
- ☆☆
Reprint requests: Roger G. Faix, MD, Box 0254, F5790 Mott, University of Michigan Medical Center, 200 E. Hospital Dr., Ann Arbor, MI 48109-0254.
- ★
0022-3476/98/$5.00 + 0 9/22/90680