Evaluation of Children Receiving Tissue Plasminogen Activator Therapy for Thrombosis: Single Center Experience

INTRODUCTION: In this retrospective study, our objective was to evaluate the children with arterial or venous thromboembolism, who were treated with tissue plasminogen activator (tPA) in our hospital.
METHODS: The medical records of 56 tPA treatments administered to 53 patients with thrombosis in the pediatric intensive care unit and pediatric clinic at X University Balcali Hospital between September 2013 and August 2018, were investigated retrospectively.
RESULTS: Thirty-three of the patients were males (58.9%). The median age was 13.5 months (1-203 months). Fifty-two of the patients received low-dose tPA treatment (91.2%) and the mean treatment duration was 63.8±43.3 hours (3-192 hours). Thrombolytic treatment was administered to 38 patients (67.8%) with the catheter-related arterial thrombus, to 8 patients (14.3%) with the intracardiac thrombus, to 4 patients (7.2%) with the pulmonary arterial thrombus, to 6 patients (10.7%) with the deep venous thrombus. No complication was observed in 47 treatments (83.9%). However, 7 patients had minor (12.5%) and 2 patients had major bleeding (3.6%). Recanalization could not be achieved in 8 cases (14.3%) and 4 patients underwent embolectomy. The use of anticoagulant treatment with tPA did not change the complication rate and the success rate of the recanalization.
DISCUSSION AND CONCLUSION: We detected that low-dose tPA treatment was effective in the treatment of life- or limb- or organ-threatening arterial and venous thromboembolism in children. However, randomized studies with larger sample sizes and control groups are required.