Urokinase in the treatment of shunt malfunctions caused by thrombus

Thrombus is a frequent cause of shunt malfunction both of the proximal end following intraventricular hemorrhage and of the distal catheter of a vascular shunt. Continued blockages may result in numerous shunt revisions until the blood has been cleared. We have treated 3 children with shunt malfunctions secondary to thrombus with urokinase, a thrombolytic agent. Two children had intraventricular hemorrhage following a shunt revision and were treated with intrashunt urokinase, and 1 with occlusion of an atrial catheter was treated with both intrashunt and systemic urokinase. All were symptomatic at the time of treatment (headaches, vomiting, full fontanel, somnolence) and all had ventriculomegaly demonstrated on computed tomography. Various dosage regimens were used with total intrashunt doses of 20,000, 50,000, and 70,000 IU. All improved clinically, computed tomography scans demonstrated improvement, and all were discharged from the hospital. There were no complications of the urokinase administration. The 2 children with proximal occlusion have not required further shunt revisions at 12 and 27 months following treatment. The infant with atrial end occlusion subsequently underwent two proximal revisions with eventual removal of the atrial catheter because of infection. We conclude the intrashunt urokinase can be of value in the treatment of shunts by blood and blood products.