Thrombolysis for intravascular thrombosis in neonates and children

Abstract

Plasminogen activators stimulate the fibrinolytic pathway to accelerate thrombus resolution and can be used to treat serious and life-threatening arterial and venous thrombosis in neonates and children. The main disadvantage of these drugs is the risk of bleeding associated with their use. This article reviews the fibrinolytic pathway and discusses the current agents available for thrombolytic therapy, as well as indications for their use, dosing regimens, safety, and efficacy. There is great variation in the drug dosing regimens used for thrombolysis and in the incidence of bleeding complications that have been reported in pediatric series. Increased experience with these drugs, appropriate patient selection, and careful monitoring appear to have reduced the risk of major bleeding over time. The use of thrombolysis for occlusive deep vein thrombosis, in attempt to reduce the long-term complication of postthrombotic syndrome, is controversial and deserves further investigation. The use of thrombolytic therapy in pediatrics has increased over the past two decades. Urokinase and recombinant tissue plasminogen activator are the currently available thrombolytic agents. Catheter-related arterial thrombi that threaten life, organ or limb are the most common indication for their use. There is a tremendous need for well designed clinical studies to improve the safety and efficacy of these drugs in neonates and children.