Combined thrombolytic and anticoagulant therapy for venous thrombosis in children.
OBJECTIVE
To evaluate safety, efficacy, and outcome after combination thrombolytic and anticoagulant therapy.


METHODS
An open nonrandomized clinical protocol with prospective standardized monitoring and data collection. Children with a documented first episode of deep vein thrombosis were treated with urokinase 4400 U/kg load and per hour with unfractionated heparin at 10 U/kg/h. At 48 hours heparin infusions were increased to achieve a therapeutic level for 5 days. Children were given therapeutic warfarin for at least 3 months. Outcome was assessed at 48 hours and > or =1 year with history, physical examination, high-resolution imaging, and Doppler ultrasonography +/- impedance and photo plethysmography.


RESULTS
Thirty-two children were treated. There was 1 thrombotic death, 1 nonfatal thrombus progression, and 1 pulmonary embolism. At 48 hours half of the children showed substantial clot lysis, and on follow-up these children had complete resolution and had no symptoms. Three children with poor early clot lysis had recurrent thromboemboli, pulmonary embolism, or both, 2 had limb pain and swelling, and 2 had asymptomatic swelling. Two children had minor bleeding, whereas systemic reactions were common.


CONCLUSIONS
Combination therapy in children (urokinase and unfractionated heparin) was safe and efficacious. A prospective, randomized, controlled study in children is needed.
Manco-Johnson
M J
MJ
Departments of Pediatrics, Surgery, and Radiology, University of Colorado Health Sciences Center and The Children's Hospital, Denver, CO, USA.
Nuss
R
R
Hays
T
T
Krupski
W
W
Drose
J
J
Manco-Johnson
M L
ML
D000293:Adolescent; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010991:Plethysmography / Q000379:methods; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents