title: Combined thrombolytic and anticoagulant therapy for venous thrombosis in children.
abstract: 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.
authors.affiliation: Departments of Pediatrics, Surgery, and Radiology, University of Colorado Health Sciences Center and The Children's Hospital, Denver, CO, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Manco-Johnson
authors.forename: R
authors.initials: R
authors.lastname: Nuss
authors.forename: T
authors.initials: T
authors.lastname: Hays
authors.forename: W
authors.initials: W
authors.lastname: Krupski
authors.forename: J
authors.initials: J
authors.lastname: Drose
authors.forename: M L
authors.initials: ML
authors.lastname: Manco-Johnson
mesh_terms: 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*
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents