Recombinant Tissue Plasminogen Activator in the Treatment of Neonates with Intracardiac and Great Vessels Thrombosis

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• 作者：Milad El-Segaier ; Muhammad A. Khan ; Zaheer Ullah Khan…
• 关键词：Thrombosis ; Tissue plasminogen activator (rTPA) ; Thrombolysis ; Neonates
• 刊名：Pediatric Cardiology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：36
• 期：8
• 页码：1582-1587
• 全文大小：864 KB
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• 作者单位：Milad El-Segaier (1) (2)
  Muhammad A. Khan (1)
  Zaheer Ullah Khan (4)
  Tarek Momenah (1)
  Mohammed Omar Galal (1) (3)
  
  1. Department of Pediatric Cardiology, King Salman Heart Center, King Fahad Medical City, PO Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia
  2. Department of Pediatric Cardiology, Sk?ne University Hospital, Lund, Sweden
  4. Department of Pediatric Hematology and Oncology, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
  3. Department of Pediatric Cardiology, Essen University, Essen, Germany
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Cardiology
  Cardiac Surgery
  Vascular Surgery
  
• 出版者：Springer New York
• ISSN：1432-1971

文摘

Life-threatening intracardiac and great vessels thrombi are rare in neonates. Recombinant tissue plasminogen activator (rTPA) is used in adults to stimulate fibrinolysis and facilitate thrombus resolution. Its use in neonates, along with heparin, remains controversial because of potential risk of serious bleeding. We aim to present our experience with the use of thrombolytic agents in seven neonates and young infants. In a retrospective study, over a period of 6 years, the medical records of neonates and young infants, who were diagnosed with intracardiac and great vessels thrombi, were reviewed. The following factors were collected: demographic data, primary diagnosis, thrombus site, risk factors, method of diagnosis, thrombolytic and/or anticoagulation agent, route, dose and duration of treatment, complications, and outcome. Six neonates and one 45-day-old infant were analyzed. Age ranged from 5 to 45 days (median age 12 days), and median weight was 2.9 kg (range 0.9-.8 kg). The thrombi were diagnosed by echocardiography in five and by angiography in two cases. All patients had life-threatening thrombi; four were treated with rTPA (0.5 mg kg? h?) and heparin infusions with complete dissolution of the thrombi, within a median time of 60 h (6-2 h), and without complications. The remaining three patients (two who were premature, at 28 and 34 weeks of gestation, and the third who had a deranged coagulation profile) were treated with unfractionated heparin due to fear of bleeding. The thrombi dissolved in the premature babies (within 2 weeks and 3 months, respectively) but embolized and resulted in the death of the third infant after 2 weeks of treatment. The current case series confirmed the effectiveness and safety of intravenous rTPA infusion, at the dosages used, in neonates and young infants with life-threatening thrombi. Keywords Thrombosis Tissue plasminogen activator (rTPA) Thrombolysis Neonates