Thrombolysis for intravascular thrombosis in neonates and children

Area of Science:

• Pediatric thrombosis and thrombolytic therapy

Background:

• Plasminogen activators target the fibrinolytic pathway to resolve thrombi.
• Thrombolytic therapy is crucial for life-threatening arterial and venous thrombosis in neonates and children.
• Bleeding risk is a significant disadvantage of thrombolytic agents.

Purpose of the Study:

• To review the fibrinolytic pathway.
• To discuss current thrombolytic agents, indications, dosing, safety, and efficacy in pediatric patients.
• To highlight the need for improved thrombolytic strategies in neonates and children.

Main Methods:

• Review of existing literature on pediatric thrombolytic therapy.
• Analysis of current thrombolytic agents: urokinase and recombinant tissue plasminogen activator.
• Examination of reported dosing regimens, safety profiles, and efficacy data.

Main Results:

• Significant variation exists in pediatric thrombolysis dosing and bleeding complication rates.
• Enhanced experience, patient selection, and monitoring have decreased major bleeding risks.
• Thrombolysis for deep vein thrombosis to prevent postthrombotic syndrome remains controversial and requires further study.

Conclusions:

• Pediatric thrombolytic therapy use has risen over the last 20 years.
• Urokinase and recombinant tissue plasminogen activator are primary agents, mainly for catheter-related arterial thrombi.
• Well-designed clinical studies are essential to enhance the safety and efficacy of thrombolysis in pediatric populations.