Tissue plasminogen activator for the treatment of thromboembolism in infants and children

• Published in: The Journal of pediatrics Vol. 118; no. 3; pp. 467 - 472
• Main Authors: Levy, Maurice, Benson, Lee N, Burrows, Patricia E., Bentur, Yedidia, Strong, Dawn K, Smith, Joanne, Johnson, David, Jacobson, Sheila, Koren, Gideon
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.03.1991; Elsevier
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Diseases of the cardiovascular system; Female; Fibrinogen - analysis; Hemorrhage - chemically induced; Heparin - administration & dosage; Heparin - therapeutic use; Humans; Infant; Infant, Newborn; Infusions, Intra-Arterial; Infusions, Intravenous; Male; Medical sciences; Partial Thromboplastin Time; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Thromboembolism - drug therapy; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; Human; Treatment; Activator; Hemopathy; Thromboembolism; Child; Coagulopathy; Fibrinolytic
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/S0022-3476(05)82170-5

We report our experience with the use of tissue plasminogen activator to treat 12 infants and children with various thromboembolic states after conventional thrombolytic agents had failed. The dosage range was between 0.1 to 0.5 mg/kg per hour. Complete clot dissolution occurred in seven cases after 2 hours to 3 days of therapy. Partial clot dissolution and clinical improvement were noted in another four patients. Bleeding complications were noted in 6 of the 12 patients and included bruising, oozing from various venipuncture sites, and bleeding; these complications were controlled by clinically available means. In all cases with bleeding the dose rate was in the higher range (0.46 to 0.50 mg/kg per hour). In one patient, restlessness, agitation, and screaming were noted during administration of tissue plasminogen activator and when it was reinstituted. We conclude that tissue plasminogen activator is effective in inducing clot lysis in children. Because the effective dose appears to overlap with those causing bleeding, we recommend that a dose of 0.1 mg/kg per hour be started and increased gradually if clot dissolution does not occur, with close monitoring for bleeding.