Central venous catheter associated thrombosis of major veins: thrombolytic treatment with recombinant tissue plasminogen activator.

Totally implantable venous catheters for chemotherapy: experience in 500 patients

“…Systemic anticoagulation was performed, initially using heparin of low molecular weight and subsequently using warfarin, thus avoiding systemic fibrinolysis due to the inherent risks of bleeding in such patients. 31 The cases of obstruction of the distal end of the catheter presented good evolution. The local fibrinolysis utilized in these cases was effective in eight of the 11 patients (preservation rate of 72.7%).…”

Management of a large organized intraatrial catheter-tip thrombus in a child with acquired immunodeficiency syndrome using escalating tissue plasminogen activator infusions

“…Thrombolytic drugs such as streptokinase or urokinase are not available in the United States or recommended for use in children and have been largely replaced by recombinant tPA (15). tPA binds to and activates fibrin clot-bound plasminogen into plasmin, restricting fibrinolysis largely to areas of thrombosis and reducing the risk of nonspecific systemic anticoagulation as compared with the earlier agents.…”

“…This recommendation was based on a review of the available literature (13). Doses as low as 0.01-0.06 mg/ kg/hr have been reported to be effective (14) and an increased risk of complications seen with higher doses (15,16). In a study involving 80 children using an avObjectives: To describe the dissolution of a large organized intraatrial catheter-tip thrombus using a novel aggressive dose escalation of tissue plasminogen activator infusion.…”

Recommendations for the use of long-term central venous catheter (CVC) in children with hemato-oncological disorders: management of CVC-related occlusion and CVC-related thrombosis. On behalf of the coagulation defects working group and the supportive therapy working group of the Italian Association of Pediatric Hematology and Oncology (AIEOP)

“…In the first small study, only four adults and one child with cancer and CVC-related thrombosis were treated with continuous infusion of rt-PA (0.5 mg/kg every 24 h, preceded by a bolus of 5 mg in adult patients or of 2 mg in the child) and UFH for 4.5 to 7.9 days. The treatment was effective in resolving the obstruction of large vessels in three of five patients, without bleeding; a partial lysis of the thrombus and a moderately severe hemorrhage were observed in the other two patients [81]. The second study involved 18 cancer patients receiving high-dose chemotherapy who developed CVC-related thrombosis; these patients were treated with UK (75,000-150,000 IU/h for 24-96 h) infused into a vein of the upper limb ipsilaterally to the thrombosis.…”