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Published on: June 4, 2021
Low-dose systemic thrombolytic therapy for deep vein thrombosis in pediatric patients
Sarah E Leary1, Virginia L Harrod, Pedro A de Alarcon
1Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA.
Insights
Low-dose systemic tissue plasminogen activator (tPA) shows promise for treating pediatric deep vein thrombosis (DVT), with a 59% overall response rate. Further research is needed to clarify bleeding risks in children undergoing thrombolysis.
Area of Science:
- Pediatric Hematology
- Vascular Medicine
- Thrombosis Treatment
Background:
- Deep vein thrombosis (DVT) in children requires effective treatment to prevent long-term complications.
- Thrombolysis is an option, but bleeding risks limit its use in pediatric patients.
- Systemic tissue plasminogen activator (tPA) offers a potential therapeutic approach.
Purpose of the Study:
- To evaluate the efficacy and safety of a low-dose systemic tPA regimen for pediatric DVT.
- To determine thrombus resolution rates and identify factors influencing treatment response.
- To assess the incidence of bleeding complications associated with low-dose tPA in children.
Main Methods:
- Retrospective analysis of pediatric DVT patients treated with low-dose systemic tPA.
- Patients received tPA at 0.03–0.06 mg/kg/h, with some escalated to 0.12 mg/kg/h.
- Thrombus resolution was assessed via imaging, and bleeding events were recorded.
Main Results:
- A 59% overall response rate (thrombus resolution) was observed by the end of therapy.
- Initial low-dose tPA achieved 30% resolution; increased doses improved response to 75% in that subgroup.
- Two non-serious bleeding complications occurred during treatment.
Conclusions:
- Low-dose systemic tPA demonstrates a substantial response rate in pediatric DVT patients.
- The risk of bleeding complications with this regimen in children requires further investigation.
- A prospective multicenter trial is warranted to confirm these findings and optimize treatment protocols.
Abstract:
Reduction of thrombus size and recanalization of vessels after deep vein thrombosis (DVT) are important goals to prevent recurrent thrombosis and development of postthrombotic syndrome. Thrombolysis is effective but concern for bleeding complications has limited its use in children. We retrospectively analyzed data for children with DVT treated with a low-dose systemic tissue plasminogen activator (tPA) regimen. Twenty-three pediatric patients (12 males and 11 females, median age 12 y) received low-dose systemic tPA, initiated at 0.03 to 0.06 mg/kg/h for a median of 24 hours (range 12 to 48 h). Of the 20 patients imaged within 24 hours of therapy, 6 (30%) showed partial to complete thrombus resolution. Eight patients subsequently received increased tPA at 0.12 mg/kg/h for an additional 24 hours (range 12 to 36 h). Six of these 8 (75%) patients responded to the increased dose. The overall response at the end of thrombolytic therapy was 59% (13/22). Two bleeding complications occurred without serious sequelae. Low-dose tPA administration leads to a substantial response rate although the risk of bleeding remains unclear. A prospective multicenter trial of low-dose thrombolytic therapy in children with acute DVT is warranted.
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