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Updated: Feb 3, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Thrombolysis Using Tissue Plasminogen Activator: Experience from a Critical Care Setting
Amna Afzal Saeed1, Qalab Abbas2, Sidra Ishaque2
11Medical College, Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, 74800 Pakistan.
Insights
Systemic tissue plasminogen activator (tPA) therapy is safe and effective for thrombolysis in critically ill children. This treatment successfully resolved clots in most pediatric intensive care unit patients with minimal adverse effects.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiovascular Thrombosis
- Pharmacology
Background:
- Thrombolysis is crucial for critically ill children with thrombotic events.
- Systemic tissue plasminogen activator (tPA) is a potential treatment option.
- Data on tPA use in pediatric intensive care units (PICUs) is limited.
Purpose of the Study:
- To evaluate the safety and efficacy of systemic tPA for thrombolysis in critically ill pediatric patients.
- To describe treatment outcomes and complications associated with tPA therapy in this population.
Main Methods:
- Retrospective review of medical records for children (1 month-16 years) treated with systemic tPA in the PICU from January 2014 to December 2017.
- Data collection included thrombus location, tPA dosage and duration, treatment outcomes (resolution, survival), and bleeding complications.
- Analysis of treatment parameters and patient outcomes.
Main Results:
- Nine critically ill children received systemic tPA therapy.
- Thrombus locations varied, including femoral artery, inferior vena cava (IVC), and intra-cardiac.
- Complete clot resolution occurred in 8 out of 9 patients; only one patient experienced self-resolving melena.
Conclusions:
- Systemic tPA therapy is a safe and effective treatment for thrombolysis in critically ill pediatric patients.
- The observed efficacy and safety profile suggest tPA can be used across various diagnoses in the PICU.
- Further research may explore optimal dosing and long-term outcomes.
Abstract:
To describe the experience of thrombolysis using tissue plasminogen activator (tPA) in critically ill children admitted to the pediatric intensive care unit (PICU), retrospective review of medical records of all children (1 month-16 years), who were admitted in PICU since January 2014 to December 2017 and received systemic tPA for thrombolysis was done. Data was collected on a structured proforma and included thrombus location, tPA dose and duration, outcome (resolution, survival) and complications (bleeding). Total 9 patients (7 males, 2 females) received systemic tPA therapy for thrombolysis with mean age of 74.64 ± 69.58 months. Two patients had thrombus in femoral artery, 3 in IVC and 4 had intra-cardiac thrombosis. Median number of doses was 2 with a range of 1-5 doses. Complete resolution of the clot was noted in all except one patient. A standard starting dose of 0.01 mg/kg/h was used in all patients. Only one patient developed melena after TPA therapy which self-resolved. Systemic tPA therapy was very safe in pediatric critically ill patients and was effective for thrombolysis and did not show any adverse effects in children with varying underlying diagnosis.
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