Successful local low-dose urokinase treatment of acquired thrombosis early after cardiothoracic surgery.
OBJECTIVE
Recent surgery (<or=10 days) is considered an absolute contraindication for thrombolytic therapy. We report the successful use of low doses of urokinase locally infused to dissolve an intravascular thrombosis in the early postoperative period after congenital heart surgery.


METHODS
Two children, with catheter-related intravascular thrombosis after cardiac surgery, received urokinase treatment within 24 hrs and 6 days of surgery, respectively.


METHODS
Tertiary, 11-bed, pediatric intensive care unit.


METHODS
Urokinase was administered through the catheter close to the site of thrombosis with a bolus of 4400 units/kg followed by a continuous infusion of 1300 units x kg(-1) x hr(-1).


RESULTS
Thrombosis resolved completely in both patients after 3 days of therapy. Signs of systemic thrombolysis were not observed.


CONCLUSIONS
A short course of local low-dose urokinase is feasible and seems to be effective for thrombolysis of catheter-related thrombosis early after cardiothoracic surgery. It was not associated with bleeding in the two cases presented. Further studies are required to confirm the safety of this approach and to define optimal dosing.
Pilloud
Jerome
J
Pediatric Intensive Care Unit, Hôpital des Enfants, Department of Pediatrics, University Hospitals of Geneva, Geneva, Switzerland.
Rimensberger
Peter C
PC
Humbert
James
J
Berner
Michel
M
Beghetti
Maurice
M