Neonatal thrombosis and the thrombolytic system: pathophysiology and therapy

In older children and adults the use of thrombolytic drugs appears to be a promising medical approach to thromboembolic disease. However, experience in newborns is limited, with both failure and success having been reported. In this article, the fibrinolytic mechanism is delineated. The similarities and differences in this mechanism between newborns and adults are indicated. It is clear that our understanding of the newborn's fibrinolytic system is limited. Thrombolytic therapy is reviewed. It is recommended that future clinical studies be designed to include three essential features: (a) a uniform clinical staging, (b) a dose-response relationship with a plasminogen activator based on in vivo and in vitro studies, and (c) detailed studies of the newborn's fibrinolytic mechanism before and during thrombolytic therapy.