Thrombolysis Using Tissue Plasminogen Activator: Experience from a Critical Care Setting.

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.