title: Successful thrombolysis by prolonged low-dose alteplase in catheter-directed infusion.
abstract: 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.
authors.affiliation: Departments of Paediatrics, The National Hospital, Oslo, Norway. ellen.ruud@rikshospitalet.no
authors.forename: E
authors.initials: E
authors.lastname: Ruud
authors.forename: H
authors.initials: H
authors.lastname: Holmstrøm
authors.forename: I
authors.initials: I
authors.lastname: Aagenaes
authors.forename: G
authors.initials: G
authors.lastname: Hafsahl
authors.forename: M
authors.initials: M
authors.lastname: Handeland
authors.forename: A
authors.initials: A
authors.lastname: Kyte
authors.forename: F
authors.initials: F
authors.lastname: Brosstad
mesh_terms: 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*
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator