title: The use of alteplase for the resolution of an intravesical clot in a neonate receiving extracorporeal membrane oxygenation.
abstract: We present a case of the use of alteplase for the lysis of a large urinary bladder clot. A neonate presented with respiratory failure, secondary to a left diaphragmatic hernia necessitating the need for extracorporeal membrane oxygenation (ECMO) support. On day 3 of ECMO support, hematuria was noted, and a subsequent urinary bladder ultrasound revealed a significant urinary bladder clot. Alteplase (0.5-1 mg) was instilled into the urinary bladder via a 10 French Foley catheter (Sherwood Medical, St. Louis, MO). The catheter was clamped for 1 hour, followed by irrigation with normal saline. Multiple doses of alteplase were administered, resulting in complete resolution of the bladder clot. No adverse effects were attributed to the use of the intravesical alteplase. Alteplase seems to be safe and effective for the resolution of bladder clots, thereby potentially avoiding more invasive surgical procedures.
authors.affiliation: Division of Critical Care Medicine, Miami Children's Hospital, Florida 33155-3009, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Olarte
authors.forename: M L
authors.initials: ML
authors.lastname: Glover
authors.forename: B R
authors.initials: BR
authors.lastname: Totapally
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006417:Hematuria / Q000209:etiology; D006548:Hernia, Diaphragmatic / Q000150:complications; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000209:etiology / Q000628:therapy; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator