62. Recombinant tissue plasminogen activator in neonates: Potential risks and benefits

Abstract

Life-threatening intra-cardiovascular thrombi are rare in neonates. Recombinant tissue plasminogen activator (rTPA) which stimulates fibrinolysis, is used in adults to facilitate thrombus resolution. Its use along with heparin in neonates remains controversial because of potential risk of serious bleeding. Our aim was to present our experience with the use of thrombolytic agents in seven neonates and young infants. Methods and patients All neonates and one 45 days old infant, between Jan. 2008 and Jan. 2014, with intracardiac and/or intravascular thrombii who were treated either by thrombolytic agents or by heparin alone were included. The following factors were collected: demographic data, primary diagnosis, and site of thrombus, risk factors, method of diagnosis, route and duration of treatment, dosage of thrombolytic and/or anticoagulation agent, complications and outcome. Results Seven patients were identified. Age range was from five days to 45 days (median age 12 days), median weight 2.9 kg (range 0.9–3.8 kg). The thrombi were diagnosed by echocardiography in five cases and in two by angiography. All patients had life threatening thrombi; four were treated with rTPA and heparin infusions with complete dissolving of the thrombi within short time (2–96 h) without complications. The other three patients (two were premature, 28 and 34 weeks of gestation, and the other had deranged coagulation profile) were treated with unfractionated heparin due to fear of bleeding. The thrombus was dissolved in the premature babies and embolized in the other one, which led to his death. Conclusion Our small case series, confirmed the effectiveness and safety of the used dosage of intravenous infusion of recombinant tissue plasminogen activator in neonates with life threatening thrombi.