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[Successful lysis of a septic thrombosis of the superior vena cava using recombinant tissue-plasminogen activator]
D Schranz1, D Haugwitz, B Zimmer
1Universitätskinderklinik, Mainz.
Insights
Recombinant human tissue-type plasminogen activator (rt-PA) effectively treated superior vena cava thrombosis in a child. Further research is needed to confirm rt-PA
Area of Science:
- Pediatric Thrombosis
- Thrombolytic Therapy
- Vascular Medicine
Background:
- Septic thrombosis of the superior vena cava is a rare but serious condition in children.
- Current treatment options may have limitations, necessitating exploration of novel therapeutic approaches.
Observation:
- A 1.7-year-old child with confirmed superior vena cava thrombosis received recombinant human tissue-type plasminogen activator (rt-PA) via central vein.
- The rt-PA therapy involved a specific dosage regimen: a 0.2 mg/kg bolus followed by a 0.8 mg/kg infusion over 60 minutes.
- This treatment was administered 12 hours after initial urokinase and heparin therapy.
Findings:
- The child exhibited a prompt clinical response to rt-PA therapy.
- No adverse clinical side effects or significant alterations in the plasmatic coagulation profile were observed during treatment.
Implications:
- These findings suggest rt-PA may be a viable treatment option for pediatric superior vena cava thrombosis.
- Further investigation is warranted to establish definitive efficacy, optimal dosing, safety profiles, and contraindications for rt-PA in pediatric thrombotic diseases.
Abstract:
Recombinant human tissue-type plasminogen activator (rt-PA) was successfully given via central vein to a 1.7 year old child with angiographically documented septic vena cava superior thrombosis Thrombolytic therapy with rt-PA was started with 0.2 mg/kg as a slow bolus injection followed by an infusion of 0.8 mg/kg over 60 min. rt-PA was applicated 12 hours after an urokinase bolus in a dosage of 8000 E/kg and heparin infusion of 500 E/kg/die. No clinical side effects or alterations in the plasmatic coagulation profile were noted. The prompt clinical response suggests that the use of rt-PA in thrombotic disease should be investigated further to establish efficacy, dosing guidelines, complication rates, and contraindications in childhood.