Early intracardiac thrombosis in preterm infants and thrombolysis with recombinant tissue type plasminogen activator

Ferrari, Fabrizio; Vagnarelli, Fabio; Gargano, Giancarlo; Roversi, Maria Federica; Biagioni, O; Ranzi, Andrea; Cavazzuti, G. B.

doi:10.1136/fn.85.1.f66

Cited by 54 publications

(55 citation statements)

References 20 publications

(13 reference statements)

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“…Thrombosis of the left atrium and left appendage is rare in neonates and infants. Ferrari et al [2] described it as a complication in premature infants with central venous catheters. Thrombus of the left atrium associated with cardiac abnormalities has been described in the literature and the Canadian and International Registry of Neonatal Thrombosis has recognized infants with congenital heart disease to be at increased risk of thrombotic complication [1].…”

Section: Discussionmentioning

confidence: 98%

“…As shown in this case, the use of a small, high-frequency neonatal echocardiographic transducer can have good echogenicity. Treatment of intracardiac thrombi in asymptomatic neonates is not univocal [2,4]. The Canadian and International Registry of Neonatal Thrombosis classified treatment of thrombus into four major categories: supportive care, anticoagulation, fibrinolysis, and surgery [1] since there is no therapeutic trial concerning the pharmacological approach of atrial thrombosis in newborns.…”

Section: Discussionmentioning

confidence: 99%

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Unusual intraatrial thrombus in a neonate with coarctation of the aorta

Abid

Ameur

et al. 2014

Archives de Pédiatrie

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Unusual intraatrial thrombus in a neonate with coarctation of the aorta

Abid

Ameur

et al. 2014

Archives de Pédiatrie

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“…Y el tratamiento antibiótico se debe instaurar ante la sospecha diagnostica, el fracaso del tratamiento médi-co en pacientes con vegetaciones persistentes pueden hacerlo pensar en una intervención quirúrgica, sopesando los riesgos vs los beneficios 15,16 . Cuando existe trombosis de vena cava inferior o trombosis de la aurícula derecha, como fue el caso de este paciente, una revisión sistemática sugiere que una trombosis de la aurícula derecha pequeña menor de 2 cm en cada dimensión e inmóvil pueden ser tratado de manera conservadora, porque la trombectomia o terapia trombolítica conlleva un riesgo significativo de mortalidad quirúrgica y sangrado 17,18 . Un reporte de caso 16 , mostró 31 ciclos de terapia trombolítica realizada en 23 neonatos con trombosis de VCI, la infusión continua de trombolíticos (n = 26) o la aplicación repetida de trombolíticos a corto plazo (n = 4) dio como resultado la recanalización completa y parcial de la vena cava inferior en 12 casos y 3 casos respectivamente, pero se fracasó en 8.…”

Section: Discussionunclassified

Trombosis de vena cava inferior y endocarditis en un paciente prematuro: Caso clínico

Buitrago

Zuluaga

Murillo

2014

Rev. chil. pediatr.

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inferior vena cava thrombosis and endocarditis in a premature patient -Case reportThrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. objectives: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. Case report: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. Conclusions: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis. (Key words: Neonatal bacteremia, central venous catheter, endocarditis, thrombosis). Rev Chil Pediatr 2014; 85 (6): 708-713 resumen La trombosis de la vena cava inferior corresponde a un porcentaje importante de las trombosis venosas en la etapa neonatal, generalmente asociado a factores de riesgo como el uso de catéter venoso central. La incidencia de endocarditis bacteriana en recién nacidos prematuros es baja. objetivos: Caracterizar el caso de un neonato pretérmino en que se asociaron ambas patologías y detallar el espectro cambiante de esta enfermedad en la población neonatal y sus posibilidades terapéuticas. Caso clínico: Recién nacido prematuro de 31 + 5 semanas de gestación, que presentó bacteriemia por Enterococo faecalis, evolucionó con trombosis progresiva de la vena cava inferior y aurícula derecha secundaria al uso de catéter venoso umbilical, con posterior diagnóstico de endocarditis. Se manejó con anticoagulación con heparina de bajo peso molecular en forma subcutánea, CASO CLíNICO Rev Chil Pediatr 2014; 85 (6): 708-713

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“…In recent years, use of low molecular mass Heparin (enoxaparin) and newer plasminogen activators including recombinant tissue-type plasminogen activator have shown promising results for alternative thrombolytic treatment in the neonatal period. 9,10 Tridimensional echocardiography was extremely useful in serial evaluation of this intracardiac thrombus. This has also been shown in one previous case report.…”

Section: Discussionmentioning

confidence: 99%