Paediatric acute basilar thrombosis successfully treated with intravenous alteplase

Sousa, Paulo Rego; Vasconcellos, Rui

doi:10.1136/bcr.10.2011.4973

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…Systemic intravenous r‐TPA has been employed to treat thromboembolic events in children worldwide. Such events include thrombotic venous catheter occlusion, 4 intra‐cardiac thrombus, 12 childhood stroke, 13 femoral artery thrombosis, vena cava thrombosis among others 14,15 . In our institution, r‐TPA has been used successfully in the treatment of thromboembolic events in children after cardiovascular surgeries.…”

Section: Discussionmentioning

confidence: 99%

Early hepatic arterial thrombosis in liver transplantation: Systemic intravenous alteplase as a potential rescue treatment after failed surgical revascularization

Feier

Melere

Trein

et al. 2020

Pediatric Transplantation

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eHAT is one of the most dreaded post-LT complication. Treatment approaches include retransplantation, revascularization, or observation. Systemic thrombolytic therapy is used in pediatric patients with thromboembolic events. However, there is no previous study reporting on the use of systemic r-tPA to treat eHAT. The treatment strategies used in patients with eHAT are described, focusing on two children who failed SR and were treated with systemic heparinization plus systemic r-tPA infusion. r-tPA-RP consists of intravenous systemic infusion at a dose of 0.3 mg/kg/h during 6 hours, for 5 days. First case (3-year) was transplanted with a whole liver, and second case (6year) received a LLS from a living donor. HAT was diagnosed by doppler US and confirmed by angioCT scan in both patients in the first day after LT. They underwent SR and were clinically stable. Re-thrombosis occurred in both patients the day after, and r-TPA-RP was started-one patient required two r-TPA-RP for HAT recurrence. They presented minor bleeding, without repercussion. Hepatic artery recanalized after 10 and 3 days in the first and second patient, respectively. Retransplant was avoided, and one developed biliary strictures, successfully managed in the follow-up. r-TPA-RP avoided retransplantation after eHAT in these cases. To our knowledge, this is the first report of the use of systemic r-TPA to treat eHAT in children. This strategy may compose an algorithm to treat eHAT that failed SR in stable patients.

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