Recombinant tissue‐type plasminogen activator treatment in an extremely low birth weight infant

Abstract

Tissue plasminogen activator can effectively treat clinical thrombosis in premature infants 11 hours after birth.

Is recombinant tissue plasminogen activator treatment a safe choice in very and extremely preterm infants with intracardiac thrombosis?

“…Bolus dose of rt-TPA was administrated in nine cases with a dosage range of 0.05–1 mg/kg intravenously 14 15 18–21 24. We found that the following continuous infusion of rt-TPA was highly heterogeneous both in terms of dosage (range 0.01–1.2 mg/kg/hour)13 23 and duration (range 1–13 days) 13–15 18 19 21 23. Low-dose rt-TPA was given to 16 of 28 neonates,13–18 20 22 24 while the remaining subjects received high-dose rt-TPA 13 14 18 19 21 23.…”

“…Reviewing the literature, 12 studies which reported 28 very or extremely preterm neonates who had pharmacological thrombolysis with rt-TPA for intracardiac thrombi were found13–24 (table 1). Their GA ranged from 23 to 31 weeks14 25 with a birth weight from 544 to 1300 g 13 21. The age at diagnosis of thrombosis was from 1 to 54 days of life 18 20.…”

“…We found that the following continuous infusion of rt-TPA was highly heterogeneous both in terms of dosage (range 0.01–1.2 mg/kg/hour)13 23 and duration (range 1–13 days) 13–15 18 19 21 23. Low-dose rt-TPA was given to 16 of 28 neonates,13–18 20 22 24 while the remaining subjects received high-dose rt-TPA 13 14 18 19 21 23. Major complications occurred in four neonates (14%): three developed intraventricular haemorrhage (IVH), whose severity was not detailed, and one pulmonary haemorrhage 13 14 23.…”

“…Three of these adverse events occurred in patients treated with high-dose rt-TPA 14 23. Complete resolution of clot was reported in 20 cases (71.4%),13–18 20–22 25 26 partial resolution in 4 (14%)13 14 16 23 and no resolution in 2 (7.1%) 13. Eleven patients received prophylaxis with heparin after thrombolysis although the dosage and duration were heterogeneous 14 15 20 24 26…”