Successful thrombolysis by prolonged low-dose alteplase in catheter-directed infusion.
Catheter-directed thrombolysis is a sophisticated method in the treatment of thromboembolism with maximum effect on the thrombus and minimal systemic effect. The consequences are enhanced local thrombolysis and a reduction in general bleeding tendency, compared with systemic thrombolysis. At our institution, two children had successful thrombolysis by prolonged continuous catheter-directed low-dose alteplase. The first patient, a boy with Fontan physiology, was successfully treated for a massive pulmonary thromboembolism by catheter-directed very low-dose alteplase for five days. The second patient, who suffered from relapsing nephrotic syndrome, achieved satisfactory thrombolysis of an arterial leg thrombosis after four days of continuous catheter-directed low-dose alteplase.


CONCLUSIONS
Although catheter-directed thrombolysis seems to be a valuable method in thrombolytic therapy, there is a lack of evidence-based recommendations concerning dosage, effect of bolus, simultaneous anticoagulation and duration of treatment for children.
Ruud
E
E
Departments of Paediatrics, The National Hospital, Oslo, Norway. ellen.ruud@rikshospitalet.no
Holmstrøm
H
H
Aagenaes
I
I
Hafsahl
G
G
Handeland
M
M
Kyte
A
A
Brosstad
F
F
D002406:Catheterization, Peripheral; D002407:Catheterization, Swan-Ganz; D002648:Child; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011150:Popliteal Artery; D011651:Pulmonary Artery; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator