title: Superior vena cava thrombus treated with low-dose, peripherally administered recombinant tissue plasminogen activator in a child: case report and review of the literature.
abstract: Thrombotic complications in pediatrics are more common today due to our ability to treat complicated diseases. In pediatric patients where thrombolytic therapy is indicated, the lack of evidence-based medicine forces practitioners to extrapolate dose recommendations for recombinant tissue plasminogen activator (rt-PA) from adult studies. This often results in a high rate of major complications. Low-dose rt-PA is an option that is effective and safe. The authors describe a child with septic thrombus of the superior vena cava who was successfully treated with low-dose, peripherally administered rt-PA, and review the efficacy and safety of standard- versus low-dose rt-PA in children. A Medline search was completed for the use of standard- and low-dose rt-PA in children with thromboembolic disease. Five studies large enough to present efficacy and safety data on standard- and/or low-dose t-PA use in children and neonates were analyzed. Two studies using low-dose rt-PA reported efficacy rates equal to or greater than those reported for standard-dose regimens. Rates of major complications were approximately 5% for low-dose regimens and up to 40% for standard-dose ones. Low-dose, peripherally administered rt-PA is safe and may be as effective as standard-dose rt-PA. A randomized controlled trial should be done to confirm this assumption.
authors.affiliation: Department of Pediatrics at Rush University Medical Center, Chicago, IL 60612, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Fasano
authors.forename: Paul
authors.initials: P
authors.lastname: Kent
authors.forename: Leonard
authors.initials: L
authors.lastname: Valentino
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000150:complications / Q000188:drug therapy; D002406:Catheterization, Peripheral; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D017984:Enoxaparin / Q000008:administration & dosage / Q000627:therapeutic use; D004927:Escherichia coli Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications / Q000188:drug therapy; D008297:Male; D017713:Platelet Transfusion; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000627:therapeutic use; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator