Failure of systemic thrombolytic and heparin therapy in the treatment of neonatal aortic thrombosis.
An unsuccessful attempt was made to lyse a large aortic thrombus in a newborn using systemic high-dose streptokinase and urokinase therapy and subsequently the use of heparin failed to prevent the propagation of thrombus. The patient was a seven-day old premature, sick neonate in whom an aortic thrombosis developed following umbilical artery catheterization. Surgical thrombectomy could not be performed in this patient, and local thrombolytic therapy was not technically feasible. Systemic thrombolytic therapy failed to induce any noteable clinical or laboratory response, and the use of heparin failed to prevent thrombus extension. Experience with the use of fibrinolytic agents in neonates is limited. Local therapy has been variably effective, and systemic therapy has not been adequately investigated. The thrombotic phenomenon in neonates and the role of umbilical vessel catheterization as a cause are discussed in reference to this patient and suggestions are made regarding the management of similar cases.
D001018:Aortic Diseases / Q000188:drug therapy* / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D013300:Streptokinase / Q000627:therapeutic use*; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D014469:Umbilical Arteries; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*
D006493:Heparin; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator