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[Successful partial lysis of a 4-level-thrombosis by rt-PA - case report]
K Schmidt1, S Gutsche, H Lorch
1Klinik für Kinder- und Jugendmedizin. Institut für Radiologie, Germany.
Klinische Padiatrie
|April 25, 2002
Summary
Systemic thrombolysis using recombinant tissue plasminogen activator (rt-PA) effectively treated severe venous thrombosis in a pediatric patient. This approach, while not standard, offers a viable option for complex cases in adolescents.
Area of Science:
- Vascular Medicine
- Pediatric Thrombosis
- Interventional Cardiology
Background:
- Venous thromboembolism (VTE) in children and adolescents presents unique challenges.
- Identifying thrombogenic risk factors is crucial for effective management.
- Severe VTE necessitates aggressive therapeutic strategies.
Observation:
- A 13-year-old female presented with extensive left lower limb deep vein thrombosis (DVT).
- Identified risk factors included APC resistance, homocystinuria, oral contraception, and smoking.
- Symptoms included significant pain, prompting immediate intervention.
Findings:
- Continuous systemic thrombolysis with recombinant tissue plasminogen activator (rt-PA) and heparin was administered for 6 days.
- Diagnostic imaging revealed complete recanalization of the inferior vena cava and iliac veins.
- Distal leg veins remained occluded; a cava filter was placed, resulting in only mild pulmonary embolism.
- The treatment was well-tolerated with no major complications.
Implications:
- Systemic thrombolysis with rt-PA can be an effective treatment for severe VTE in pediatric patients.
- This therapeutic option, though not routine, should be considered in complex adolescent thrombosis cases.
- Careful monitoring and adjunctive measures like cava filters are essential for safety.
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