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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Treatment of thrombosis in KD Patients using tissue plasminogen activator: a single center study
Yanqiu Chu1, Yunming Xu1, Ce Wang1
1Pediatric department of shengjing hospital, China Medical University, 110004, shenyang, China.
Insights
Alteplase and anticoagulation effectively dissolve coronary thrombosis in children with Kawasaki disease, improving blood flow and quality of life. This treatment shows promise even beyond the typical 12-hour window for thrombolysis.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Thrombosis Management
Background:
- Giant coronary aneurysms in Kawasaki disease (KD) pose a risk of ischemic cardiomyopathy due to thrombosis.
- Effective thrombolytic therapy is crucial for improving long-term outcomes in affected children.
Purpose of the Study:
- To evaluate the efficacy of Alteplase combined with anticoagulation in treating coronary artery thrombosis in pediatric KD patients.
- To assess the impact of this regimen on thrombosis resolution and coronary artery blood flow.
Main Methods:
- Four male pediatric patients with KD and coronary artery thrombosis received Alteplase and heparin, followed by warfarin, aspirin, and clopidogrel.
- Treatment duration and outcomes were monitored for thrombosis dissolution and clinical improvement.
Main Results:
- Significant dissolution of coronary artery thromboses was observed in all patients within 9 days to 2 months.
- The combined thrombolytic and anticoagulation therapy successfully diminished thrombosis complications, improving coronary artery blood flow.
Conclusions:
- Alteplase-based thrombolysis is effective for coronary aneurysms with thrombosis in KD patients, even for thromboses older than 12 hours.
- This treatment strategy can improve or restore coronary artery blood flow, potentially preventing severe complications like ischemic cardiomyopathy.
- Recurrence of thrombosis is a concern, necessitating ongoing management and monitoring.
Objective:
The most severe complication associated with giant coronary aneurysm in children with Kawasaki disease is ischemic cardiomyopathy (ICM) caused by thrombosis. Addition of tissue plasminogen activator, Alteplase, in the treatment regimen can be an efficient thrombolytic therapy, and therefore can have a significantly positive impact on patients' quality of life in long term.
Methods:
Total four male KD patients with central thromboses in coronary aneurysm were treated in Pediatric Cardiology Department of Shengjing Hospital, China Medical University, from January 2020 to August 2021. These patients received thrombolytic treatments including Alteplase once + Heparin for 1 week followed by continuous oral Warfarin + Aspirin + Clopidogrel.
Results:
4 young male KD patients had coronary aneurysm (CAA) complicated with total 7 occurrences of central thrombosis. These patients were given alteplase and heparin/oral Warfarin + Aspirin + Clopidogrel treatment. 9 days to 2 months later, thromboses were significantly dissolved. The treatment successfully diminished the thrombosis complication.
Conclusion:
1. Pediatric KD patients complicated with coronary aneurysm thrombosis are prone to recurrence of thrombosis. 2. In KD patients complicated with coronary aneurysm thrombosis, treatments described in Method can be used for treating either small thromboses formed less than 1 month with strong echo and convex lumen or large thromboses with mixed strong and weak echo. With these treatments, coronary artery blood flow can be improved or completely recovered. 3. Clinical experiences at our center in treating these KD patients suggest that Alteplase can be considered in thrombolytic treatment beyond the limitation of less than 12 h of thrombosis occurrence.
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