Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study

Area of Science:

• Pediatric Hematology
• Thrombosis Treatment
• Pharmacology

Background:

• Systemic thrombolysis using recombinant tissue plasminogen activator (rtPA) is a critical intervention for pediatric thrombosis.
• Understanding treatment variations and outcomes is essential for optimizing its use in children.

Purpose of the Study:

• To evaluate the experiences and outcomes of systemic thrombolysis with rtPA in pediatric patients across multiple Turkish hematology centers.
• To analyze the impact of rtPA dosage, duration, and concomitant anticoagulation on clot resolution and bleeding complications.

Main Methods:

• A retrospective analysis of 55 thrombotic episodes in 54 pediatric patients (median age 5 years) treated between 2005 and 2019.
• Data collected from 13 Turkish pediatric hematology centers included rtPA dose, duration, anticoagulation, clot resolution rates (complete/partial), and bleeding events.
• Patients presented with various thromboses including intracardiac, deep vein thrombosis (DVT), arterial, pulmonary embolism (PE), and stroke.

Main Results:

• The median time from thrombus detection to rtPA initiation was 12 hours, significantly longer for DVT and PE.
• Low-dose (LD) and high-dose (HD) rtPA were used in 22 and 33 episodes, respectively, with significant differences in concomitant anticoagulation use (90% for LD vs. 36% for HD).
• Complete or partial clot resolution was achieved in 32.7% and 49.0% of episodes, respectively. Bleeding rates varied between LD and HD rtPA groups, with no significant correlation between HD vs. LD rtPA and resolution or bleeding outcomes.

Conclusions:

• Systemic thrombolytic therapy with rtPA can be life- and organ-saving in children with high-risk thrombosis.
• Effective use requires appropriate indications, timely administration by experienced hematologists, and close monitoring for recanalization and bleeding.