Thrombolysis Using Tissue Plasminogen Activator: Experience from a Critical Care Setting


To describe the experience of thrombolysis using tissue plasminogen activator (tPA) in critically ill children admitted to the pediatric intensive care unit (PICU), retrospective review of medical records of all children (1 month–16 years), who were admitted in PICU since January 2014 to December 2017 and received systemic tPA for thrombolysis was done. Data was collected on a structured proforma and included thrombus location, tPA dose and duration, outcome (resolution, survival) and complications (bleeding). Total 9 patients (7 males, 2 females) received systemic tPA therapy for thrombolysis with mean age of 74.64 ± 69.58 months. Two patients had thrombus in femoral artery, 3 in IVC and 4 had intra-cardiac thrombosis. Median number of doses was 2 with a range of 1–5 doses. Complete resolution of the clot was noted in all except one patient. A standard starting dose of 0.01 mg/kg/h was used in all patients. Only one patient developed melena after TPA therapy which self-resolved. Systemic tPA therapy was very safe in pediatric critically ill patients and was effective for thrombolysis and did not show any adverse effects in children with varying underlying diagnosis.

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  1. 1.

    Chan AK, Monagle P (2012) Updates in thrombosis in pediatrics: where are we after 20 years? Hematol Am Soc Hematol Educ Program 2012:439–443

    Google Scholar 

  2. 2.

    Albisetti M, Schmugge M, Haas R, Eckhardt BP, Bauersfeld U, Baenziger O et al (2005) Arterial thromboembolic complications in critically ill children. J Crit Care 20(3):296–300

    Article  Google Scholar 

  3. 3.

    Raffini L, Huang YS, Witmer C, Feudtner C (2009) Dramatic increase in venous thromboembolism in children’s hospitals in the United States from 2001 to 2007. Pediatrics 124(4):1001–1008

    Article  Google Scholar 

  4. 4.

    Polikoff LA, Faustino EV (2014) Venous thromboembolism in critically ill children. Curr Opin Pediatr 26(3):286–291

    CAS  Article  Google Scholar 

  5. 5.

    Gupta AA, Leaker M, Andrew M, Massicotte P, Liu L, Benson LN et al (2001) Safety and outcomes of thrombolysis with tissue plasminogen activator for treatment of intravascular thrombosis in children. J Pediatr 139(5):682–688

    CAS  Article  Google Scholar 

  6. 6.

    Albisetti M (2006) Thrombolytic therapy in children. Thromb Res 118(1):95–105

    CAS  Article  Google Scholar 

  7. 7.

    Evim MS, Bostan O, Baytan B, Semizel E, Gunes AM (2013) Thrombolysis with recombinant tissue plasminogen activator in 7 children. Clin Appl Thromb Hemost 19(5):574–577

    Article  Google Scholar 

  8. 8.

    Ansah DA, Patel KN, Montegna L, Nicholson GT, Ehrlich AC, Petit CJ (2016) Tissue plasminogen activator use in children: bleeding complications and thrombus resolution. J Pediatr 171(67–72):e1–e2

    Google Scholar 

  9. 9.

    Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U et al (2012) Antithrombotic therapy in neonates and children: antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e737S–e801S

    CAS  Article  Google Scholar 

  10. 10.

    Wang M, Hays T, Balasa V, Bagatell R, Gruppo R, Grabowski EF et al (2003) Low-dose tissue plasminogen activator thrombolysis in children. J Pediatr Hematol Oncol 25(5):379–386

    Article  Google Scholar 

  11. 11.

    Hartmann J, Hussein A, Trowitzsch E, Becker J, Hennecke KH (2001) Treatment of neonatal thrombus formation with recombinant tissue plasminogen activator: six years experience and review of the literature. Arch Dis Child Fetal Neonatal Ed 85(1):F18–F22

    CAS  Article  Google Scholar 

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Correspondence to Qalab Abbas.

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The authors declare that they have no conflict of interest.

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Aga Khan University 4893-PED-ERC-17.

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Saeed, A.A., Abbas, Q., Ishaque, S. et al. Thrombolysis Using Tissue Plasminogen Activator: Experience from a Critical Care Setting. Indian J Hematol Blood Transfus 34, 723–726 (2018).

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  • Systemic tPA
  • Children
  • Thrombolysis