Combined thrombolytic and anticoagulant therapy for venous thrombosis in children

• Published in: The Journal of pediatrics Vol. 136; no. 4; pp. 446 - 453
• Main Authors: Manco-Johnson, Marilyn J, Nuss, Rachelle, Hays, Taru, Krupski, William, Drose, Julia, Manco-Johnson, Michael L
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2000; Elsevier
• Subjects: Adolescent; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Child; Child, Preschool; Drug Therapy, Combination; Female; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Humans; Infant; Male; Medical sciences; Pharmacology. Drug treatments; Plethysmography - methods; Prospective Studies; Pulmonary Embolism - blood; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - drug therapy; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - statistics & numerical data; Treatment Outcome; Ultrasonography; Venous Thrombosis - blood; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - drug therapy; Human; Drug combination; Warfarin; Coumarine derivatives; Treatment efficiency; Cardiovascular disease; Anticoagulant; Thrombosis; Venous disease; Vascular disease; Antivitamin K; Chemotherapy; Adolescent; Glycosaminoglycan; Deep vein; Heparin; Urokinase(drug); Child; Fibrinolytic
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(00)90006-4

Objectives: To evaluate safety, efficacy, and outcome after combination thrombolytic and anticoagulant therapy. Study design: An open nonrandomized clinical protocol with prospective standardized monitoring and data collection. Children with a documented first episode of deep vein thrombosis were treated with urokinase 4400 U/kg load and per hour with unfractionated heparin at 10 U/kg/h. At 48 hours heparin infusions were increased to achieve a therapeutic level for 5 days. Children were given therapeutic warfarin for at least 3 months. Outcome was assessed at 48 hours and ≥1 year with history, physical examination, high-resolution imaging, and Doppler ultrasonography - impedance and photo plethysmography. Results: Thirty-two children were treated. There was 1 thrombotic death, 1 nonfatal thrombus progression, and 1 pulmonary embolism. At 48 hours half of the children showed substantial clot lysis, and on follow-up these children had complete resolution and had no symptoms. Three children with poor early clot lysis had recurrent thromboemboli, pulmonary embolism, or both, 2 had limb pain and swelling, and 2 had asymptomatic swelling. Two children had minor bleeding, whereas systemic reactions were common. Conclusions: Combination therapy in children (urokinase and unfractionated heparin) was safe and efficacious. A prospective, randomized, controlled study in children is needed.