Tissue Plasminogen Activator Use in Children: Bleeding Complications and Thrombus Resolution

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• 作者：Deidra A. Ansah ; MD¹ ; Kavita N. Patel ; MD¹ ; ² ; ³ ; ⁴ ; Leticia Montegna ; PharmD⁴ ; George T. Nicholson ; MD¹ ; ⁴ ; ⁵ ; Alexandra C. Ehrlich ; MPH⁵ ; Christopher J. Petit ; MD¹ ; ⁴ ; ⁵ ; ^{cjpetit@emory.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：CHD ; Congenital heart disease ; ICU ; Intensive care unit ; PICU ; Pediatric ICU ; tPA ; Tissue plasminogen activator
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：171
• 期：Complete
• 页码：67-72.e2
• 全文大小：524 K

文摘

To review our institutional experience with tissue plasminogen activator (tPA) to determine outcomes related to bleeding complications and thrombus resolution.

ec_2">Study design

ra0015">We performed a retrospective review of all patients who received systemic tPA for thrombolysis. Data points included location of thrombus, initial and maximum tPA dose, and duration of tPA. The primary endpoint was bleeding complication.

ec_3">Results

ra0020">Between 2005 and 2014, 46 patients received systemic tPA for thrombolysis: 17 (37%) were patients with a primary cardiac diagnosis, there were 17 (37%) hematology/oncology patients, and 12 (26%) patients with noncardiac, nonhematology/oncology diagnoses. The indication for tPA was central venous thrombus (n = 23), pulmonary artery thrombus (n = 9), and cardiac or aortic thrombus (n = 14). Bleeding complications occurred in 15 patients (33%). Median initial tPA dose in the bleeding complication group was 0.10 mg/kg/h vs 0.03 mg/kg/h in the group without bleeding complication group (<em>Pem> = .01). Cardiac patients experienced more bleeding complications (<em>Pem> = .01). Multivariate analysis indicated that dose of tPA (<em>Pem> = .01) and diagnostic category (<em>Pem> < .01) were associated with bleeding complication. Complete thrombus resolution occurred in 21 patients, partial in 10 patients, and no resolution in 15 patients. Complete resolution of thrombus was not associated with diagnosis, thrombus location, tPA dose, or duration.

ec_4">Conclusions

ra0025">Cardiac patients appear to be at highest risk of bleeding complication; bleeding complications were associated with higher doses of tPA, and cardiac patients were the cohort who received the highest doses of tPA. Higher tPA doses are associated with increased risk of bleeding complication but are not associated with successful thrombus resolution.