title: The effects of ranitidine and hydrocortisone on the complications of femoral artery obstruction treated by streptokinase following cardiac catheterization in pediatric patients with congenital heart diseases.
abstract: BACKGROUND
  The most important complication following cardiac catheterization required urgent therapeutic management is vessel obstruction and arterial thrombosis. The morbidity following this complication can be decreased by surgery intervention and/or thrombolytic drugs.
  
  
  OBJECTIVE
  In this study we evaluated the effects of ranitidine and hydrocortisone on pediatric patients with congenital heart diseases who suffered from femoral artery obstruction following cardiac catheterization on decreasing the events after streptokinase administration.
  
  
  METHODS
  This semi experimental study was conducted on 47 patients among 600 cases who underwent cardiac catheterization from April 2002 to December 2011.The patients suffered from distal vessel obstruction following cardiac catheterization with no response to surgery intervention, were enrolled and divided in two groups. Streptokinase was administrated in both groups. Patients in group 2 (25 cases), received ranitidine and hydrocortisone before streptokinase administration. In group 1 (22 cases), the loading dose of streptokinase was 2000IU/kg/ in 20-30 minutes/ infusion and thereafter streptokinase was administrated 1000 IU /kg/hour. In group 2, the loading dose was 3000IU/kg in 20-30 minutes /infusion and 1500 IU/kg/hour as maintenance dose. The infusion dose of streptokinase was decreased and then terminated in 2-3 hours by the time arterial pulse was detected by pulse oximetry.
  
  
  RESULTS
  There were 13 (59, 1%) male and 9 (40.9%) female patients in group 1. In group 2, there were 15 (60%) male and 10 (40%) female cases (P = 0.949). Patients in both groups were matched well regarding age, body weight, height and the duration of streptokinase infusion (P < 0.05). The incidence of hematoma was higher in group 1 than group 2 (P = 0.032). the patients of Group 1 required more blood transfusion than group 2 because the incidence of bleeding was more in the first group (P = 0.042). 12 patients in group 1 required fresh frozen plasma transfusion versus 4 patients in group 2 (P = 0.049). Local oozing was detected more in group 1 (P = 0.042). Significant bleeding was occurred in 6 cases in group 1; however this event did not occurrin any patients in group 2 (P = 0.007). Although 4 patients in group 1 suffered from anaphylactic shock after streptokinase administration but no patients in group 2 did. (P = 0.041).
  
  
  CONCLUSIONS
  Based on the results of this study, we concluded that streptokinase was able to remove the vessel thrombosis at the site of cardiac catheterization and ranitidine and hydrocortisone administration before streptokinase may be effective in order to reduce the complications related to thrombolytic drugs; however the experience of the performer is an issue of concern in this matter.
authors.affiliation: Research Center for Children and Adolescent Health, ALI-EBN E-ABITALEB Hospital, Zahedan University of medical sciences, Zahedan, IR Iran.
authors.forename: Noormohammad
authors.initials: N
authors.lastname: Noori
authors.affiliation: Research Center for Children and Adolescent Health, ALI-EBN E-ABITALEB Hospital, Zahedan University of medical sciences, Zahedan, IR Iran.
authors.forename: Ghasem
authors.initials: G
authors.lastname: Miri Aliabad
authors.affiliation: Research Center for Children and Adolescent Health, ALI-EBN E-ABITALEB Hospital, Zahedan University of medical sciences, Zahedan, IR Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mohammadi
authors.affiliation: Research Center for Children and Adolescent Health, ALI-EBN E-ABITALEB Hospital, Zahedan University of medical sciences, Zahedan, IR Iran.
authors.forename: Maziar
authors.initials: M
authors.lastname: Mahjoubifard
authors.affiliation: Fellowship of Cardiac Anesthesia, Rajaie Cardiovascular Medical & Research Center, Tehran University of Medical Sciences, Tehran, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Jahangiri Fard
keywords: Catheterization; Child; Streptokinase; Thrombosis