The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation

García, Alejandro; Gander, Jeffrey W.; Gross, Erica R.; Reichstein, Ari; Sheth, Sujit; Stolar, Charles J.H.; Middlesworth, William

doi:10.1016/j.jpedsurg.2011.06.039

Cited by 21 publications

(20 citation statements)

References 8 publications

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“…It also can be useful in removing clots from blocked catheters and grafts (arteriovenous shunts) (45), treatment of unusual acute thrombotic events (46), treatment of empyemas and pleural effusions (47), and to limit amputation in frostbite (48). tPA can also be useful in animal models for treating a variety of extravascular fibrin deposition disorders, including prevention of intra-abdominal adhesions (49) and clearance of airways after burns and smoke inhalation (50).…”

Section: Discussionmentioning

confidence: 99%

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Veress

Hendry‐Hofer²,

Loader³

et al. 2013

Am J Respir Cell Mol Biol

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Sulfur mustard (SM) inhalation causes the rare but life-threatening disorder of plastic bronchitis, characterized by bronchial cast formation, resulting in severe airway obstruction that can lead to respiratory failure and death. Mortality in those requiring intubation is greater than 80%. To date, no antidote exists for SM toxicity. In addition, therapies for plastic bronchitis are solely anecdotal, due to lack of systematic research available to assess drug efficacy in improving mortality and/or morbidity. Adult rats exposed to SM analog were treated with intratracheal tissue plasminogen activator (tPA) (0.15-0.7 mg/kg, 5.5 and 6.5 h), compared with controls (no treatment, isoflurane, and placebo). Respiratory distress and pulse oximetry were assessed (for 12 or 48 h), and arterial blood gases were obtained at study termination (12 h). Microdissection of fixed lungs was done to assess airway obstruction by casts. Optimal intratracheal tPA treatment (0.7 mg/kg) completely eliminated mortality (0% at 48 h), and greatly improved morbidity in this nearly uniformly fatal disease model (90-100% mortality at 48 h). tPA normalized plastic bronchitis-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress (i.e., clinical scores) while decreasing airway fibrin casts. Intratracheal tPA diminished airwayobstructive fibrin-containing casts while improving clinical respiratory distress, pulmonary gas exchange, tissue oxygenation, and oxygen utilization in our model of severe chemically induced plastic bronchitis. Most importantly, mortality, which was associated with hypoxemia and clinical respiratory distress, was eliminated.Keywords: plastic bronchitis; tissue plasminogen activator; airway obstruction; sulfur mustard; fibrin Sulfur mustard (bis(2-chloroethyl)sulfide; SM) is a vesicant and chemical weapon used in warfare during much of the twentieth century, and which remains in the stockpiles of multiple nations today (Syria, Iran, North Korea, Libya, the United States, and possibly others). SM exposure affects the eyes, skin, upper airways, and lungs. After a brief latent period, respiratory failure and death can develop within 12 to 48 hours. Despite a century of study, the mechanisms responsible for SM's toxic effects remain unsolved, and clinically effective rescue therapies or antidotes are not available.Initial reports of human SM inhalation toxicity in the early 1900s described the presence of airway-obstructive necrotic debris/ mucosa, or "pseudomembranes," in the large airways of victims, and these were more recently confirmed in the victims of the IranIraq war (1, 2). Such severe lesions have been reported to lead to respiratory compromise, with need for artificial ventilation, and death in 80% of those needing intubation (2). Furthermore, chronic conducting airway lesions, such as bronchiolitis obliterans, tracheal/bronchial stenosis, and chronic bronchitis, are commonly found in survivors of SM inhalation months to years after exposure (2, 3), whereas chronic alveolar or paren...

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Section: Discussionmentioning

confidence: 99%

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Veress

Hendry‐Hofer²,

Loader³

et al. 2013

Am J Respir Cell Mol Biol

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“…To our knowledge, only few cases of intracardiac thrombosis in ECMO patients have been reported in the literature, and all of them were treated with anticoagulants (especially in heparin‐coated circuit) or direct thrombectomy. No reports of locally administered thrombolysis have been published in adults, while the few cases reported in the pediatric population all resulted in fatal complications eventually leading to death . Similarly, we are not aware of any report of tenecteplase administration early after cardiac surgery.…”

Section: Discussionmentioning

confidence: 89%

“…No reports of locally administered thrombolysis have been published in adults, while the few cases reported in the pediatric population all resulted in fatal complications eventually leading to death. 8 Similarly, we are not aware of any report of tenecteplase administration early after cardiac surgery. Conversely, cardiac surgery after failed thrombolysis has been extensively studied, mainly in the setting of acute myocardial infarction and acute pulmonary embolism.…”

Section: Discussionmentioning

confidence: 95%

Regional Thrombolysis with Tenecteplase During Extracorporeal Membrane Oxygenation: A New Approach for Left Ventricular Thrombosis

et al. 2015

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We present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter.

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“…Имеется успешный опыт использования фибринолитических препара-тов на основе прямого ингибитора тромбина (бива-лирудин), рекомбинантного тканевого (альтеплаза) и модифицированного (фибринспецифического) активатора плазминогена (тенектеплаза) при воз-никновении тромбоза полостей сердца и аорты во время ВА ЭКМО [20][21][22]. Однако выполнение сис-темного тромболиза сопряжено с развитием тяже-лых геморрагических осложнений (прежде всего кровоизлияния в головной мозг), риск возникнове-ния которых у пациентов с ВА ЭКМО повышен на фоне предшествующей антикоагулянтной терапии (применение нефракционированного гепарина), тромбоцитопении, гипофибриногенемии и других расстройствах гемостаза [23].…”

Section: Discussionunclassified

Successful Treatment of a Recipient With Massive Thrombosis of Heart Transplant Left Chambers During Extracorporeal Membrane Oxygenation

Попцов

Захаревич

Спирина

et al. 2016

RJTAO

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1 ФГБУ «ФНЦ трансплантологии и искусственных органов им. акад. В.И. Шумакова» Минздрава России, Москва, Российская Федерация 2 Кафедра трансплантологии и искусственных органов ГБОУ ВПО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава России, Москва, Российская Федерация Представлен клинический случай успешного лечения реципиента сердца с тотальным тромбозом левого предсердия и левого желудочка, развившимся в ранние сроки после трансплантации на фоне применения периферической ВА ЭКМО как метода механической поддержки кровообращения при острой право-желудочковой недостаточности пересаженного сердца. Пациенту успешно выполнили хирургическую тромбэктомию, и ВА ЭКМО прекращена на первые сутки после операции.Ключевые слова: трансплантация сердца, экстракорпоральная мембранная оксигенация, тромбоз левого желудочка, активированное время свертывания. We present a case report of a 16-year-old man with venoarterial extracorporeal membrane oxygenation (VA-ECMO) for primary graft failure after orthotopic heart transplantation who developed left atrium and left ventricular thrombosis despite systemic anticoagulation. The surgical thrombectomy was performed and the patient was successfully weaned off the extracorporeal support on the fi rst day thereafter. SUCCESSFUL TREATMENT OF A RECIPIENT WITH MASSIVE THROMBOSIS OF HEART TRANSPLANT LEFT CHAMBERS DURING EXTRACORPOREAL MEMBRANE OXYGENATION

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The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation

Cited by 21 publications

References 8 publications

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Tissue Plasminogen Activator Prevents Mortality from Sulfur Mustard Analog–Induced Airway Obstruction

Regional Thrombolysis with Tenecteplase During Extracorporeal Membrane Oxygenation: A New Approach for Left Ventricular Thrombosis

Successful Treatment of a Recipient With Massive Thrombosis of Heart Transplant Left Chambers During Extracorporeal Membrane Oxygenation

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