Thrombolysis of a neonatal brachial artery thrombosis with tissue plasminogen activator

A case report is presented describing the use of tissue plasminogen activator (TPA) to dissolve a thrombosis in the brachial artery of a critically ill premature neonate. A short review of the literature is included.

A premature infant with pulmonary hypertension is discovered to have a concomitant right brachial artery thrombosis. A debate ensued concerning the choice of medical management to pursue after surgical extirpation was ruled out. After review of the various alternatives both traditional and novel, a decision was made to utilize TPA.

After a continuous infusion of 0.1 mg/kg per hour for 15 hours, blood flow was established distal to the previously occluded right brachial artery. No untoward side-effects occurred during or subsequent to the treatment.

TPA proved to be an extremely useful medication for the relief of a brachial artery thrombosis in this patient. The theoretical advantages, as well as several anecdotal reports of its successful use, should hopefully stimulate a large multicenter study of its use in the neonatal population.