Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study; [Çocuklarda Sistemik Rekombinant Doku Plazminojen Aktivatörü ile Tromboliz: Çok Merkezli Bir Retrospektif Çalışma]
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Date
2021
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Abstract
Objective: This study aimed to evaluate systemic thrombolysis experiences with recombinant tissue plasminogen activator (rtPA). Materials and Methods: Retrospective data were collected from 13 Turkish pediatric hematology centers. The dose and duration of rtPA treatment, concomitant anticoagulant treatment, complete clot resolution (CCR), partial clot resolution (PCR), and bleeding complications were evaluated. Low-dose (LD) rtPA treatment was defined as 0.01-0.06 mg/kg/h and high-dose (HD) rtPA as 0.1-0.5 mg/kg/h. Results: Between 2005 and 2019, 55 thrombotic episodes of 54 pediatric patients with a median age of 5 years (range: 1 day to 17.75 years) were evaluated. These patients had intracardiac thrombosis (n=16), deep vein thrombosis (DVT) (n=15), non-stroke arterial thrombosis (n=14), pulmonary thromboembolism (PE) (n=6), and stroke (n=4). The duration from thrombus detection to rtPA initiation was a median of 12 h (range: 2-504 h) and it was significantly longer in cases of DVT and PE compared to stroke, non-stroke arterial thrombosis, and intracardiac thrombosis (p=0.024). In 63.6% of the episodes, heparin was initiated before rtPA treatment. LD and HD rtPA were administered in 22 and 33 of the episodes, respectively. Concomitant anticoagulation was used in 90% and 36% of the episodes with LD and HD rtPA, respectively (p=0.0001). Median total duration of LD and HD rtPA infusions was 30 h (range: 2-120 h) and 18 h (2-120 h), respectively (p=0.044). Non-fatal major and minor bleeding rates were 12.5% and 16.7% for LD and 3.2% and 25.8% for HD rtPA, respectively. At the end of the rtPA infusions, CCR and PCR were achieved in 32.7% and 49.0% of the episodes, respectively. The most successful site for thrombolysis was intracardiac thrombosis. HD versus LD rtPA administration was not correlated with CCR/PCR or bleeding (p>0.05). Conclusion: Systemic thrombolytic therapy may save lives and organs effectively if it is used at the right indications and the right times in children with high-risk thrombosis by experienced hematologists with close monitoring of recanalization and bleeding. © 2021, Turkish Society of Hematology. All rights reserved.
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Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Retrospective Studies , Thrombolytic Therapy , Thrombosis , Tissue Plasminogen Activator , anticoagulant agent , bilirubin , enoxaparin , fibrinogen , fresh frozen plasma , heparin , progesterone , tissue plasminogen activator , tissue plasminogen activator , adolescent , anaphylaxis , anticoagulant therapy , artery thrombosis , Article , bacteremia , Behcet disease , bleeding , blood clot lysis , bone marrow biopsy , bronchiolitis , child , childhood , chronic lung disease , controlled study , deep vein thrombosis , Down syndrome , drug megadose , epilepsy , erythrocyte transfusion , Fanconi anemia , gastrointestinal hemorrhage , heart rate , hematologist , hemodialysis , human , hyperhomocysteinemia , hyperlipidemia , intracardiac thrombosis , ischemic heart disease , larynx edema , leukemia , leukocyte count , low drug dose , lung embolism , mastoiditis , mucocutaneous lymph node syndrome , multiple sclerosis , nephrotic syndrome , newborn , obesity , pediatric patient , percutaneous thrombectomy , platelet count , propionic acidemia , prothrombin time , pyelonephritis , rash , recanalization , retrospective study , systemic thrombolysis , thrombus , urticaria , clinical trial , fibrinolytic therapy , infant , multicenter study , preschool child , thrombosis