Related Experiment Videos
Tissue plasminogen activator for the treatment of thromboembolism in infants and children
M Levy1, L N Benson, P E Burrows
1Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Tissue plasminogen activator effectively dissolves blood clots in pediatric patients when other treatments fail. Careful dosing is crucial to balance efficacy and minimize bleeding risks.
Area of Science:
- Pediatric Thrombosis
- Thrombolytic Therapy
- Pharmacology
Background:
- Thromboembolic events pose significant risks in pediatric populations.
- Conventional thrombolytic agents may be ineffective for certain pediatric thromboembolic states.
Purpose of the Study:
- To evaluate the efficacy and safety of tissue plasminogen activator (tPA) in pediatric patients with thromboembolic conditions.
- To determine optimal dosing strategies for tPA in children.
Main Methods:
- Retrospective analysis of 12 pediatric patients treated with tPA for thromboembolic states.
- Dosage range of 0.1 to 0.5 mg/kg per hour was administered.
- Clinical outcomes and bleeding complications were closely monitored.
Main Results:
- Complete clot dissolution in 7 patients; partial dissolution and clinical improvement in 4 patients.
- Bleeding complications occurred in 6 patients, primarily at higher tPA doses (0.46-0.50 mg/kg/hr).
- One patient experienced adverse neurological symptoms during tPA administration.
Conclusions:
- Tissue plasminogen activator demonstrates efficacy in pediatric clot lysis.
- A cautious initial dose of 0.1 mg/kg/hr, with gradual increases and close monitoring, is recommended to mitigate bleeding risks.
Abstract:
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.