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Intrapulmonary thrombolytic therapy in a child with acute pulmonary embolism due to primary antiphospholipid syndrome

Hsin-Ju Huang1, Jieh-Neng Wang, Yu-Chien Tsai

  • 1Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, 138, Sheng Li Road, Tainan, 70428, Taiwan.

Acta Paediatrica Taiwanica = Taiwan Er Ke Yi Xue Hui Za Zhi
|March 14, 2003
PubMed

Insights

Pulmonary embolism (PE) in children is serious. Intrapulmonary streptokinase rapidly resolved clots in a pediatric patient unresponsive to heparin, suggesting a potential alternative treatment for pediatric PE.

Area of Science:

  • Pediatric Medicine
  • Cardiology
  • Hematology

Background:

  • Pulmonary embolism (PE) is a critical condition in children requiring urgent intervention.
  • Anticoagulation is the primary treatment for PE, but its efficacy can be limited.
  • Intrapulmonary thrombolytic therapy is being explored as a more targeted approach for clot lysis.

Observation:

  • A 10-year-old girl presented with extensive pulmonary emboli secondary to primary antiphospholipid syndrome.
  • Standard intravenous heparin therapy for 3 days failed to resolve the pulmonary thrombi.
  • The patient exhibited persistent thrombi despite conventional anticoagulation.

Findings:

  • Intrapulmonary streptokinase infusion was administered over 12 hours.
  • Rapid and complete resolution of the diffused multiple pulmonary emboli was observed following streptokinase therapy.
  • This localized thrombolytic approach proved effective where systemic anticoagulation failed.

Implications:

  • Intrapulmonary thrombolytic therapy, specifically with streptokinase, may offer a rapid and effective treatment for pediatric pulmonary embolism.
  • This case highlights a potential alternative for managing refractory PE in pediatric patients, particularly those with antiphospholipid syndrome.
  • Further research into localized thrombolysis could lead to improved outcomes and reduced systemic complications in pediatric thromboembolic disease.

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