title: Tissue Plasminogen Activator Use in Children: Bleeding Complications and Thrombus Resolution.
abstract: OBJECTIVE
  To review our institutional experience with tissue plasminogen activator (tPA) to determine outcomes related to bleeding complications and thrombus resolution.
  
  
  METHODS
  We performed a retrospective review of all patients who received systemic tPA for thrombolysis. Data points included location of thrombus, initial and maximum tPA dose, and duration of tPA. The primary endpoint was bleeding complication.
  
  
  RESULTS
  Between 2005 and 2014, 46 patients received systemic tPA for thrombolysis: 17 (37%) were patients with a primary cardiac diagnosis, there were 17 (37%) hematology/oncology patients, and 12 (26%) patients with noncardiac, nonhematology/oncology diagnoses. The indication for tPA was central venous thrombus (n = 23), pulmonary artery thrombus (n = 9), and cardiac or aortic thrombus (n = 14). Bleeding complications occurred in 15 patients (33%). Median initial tPA dose in the bleeding complication group was 0.10 mg/kg/h vs 0.03 mg/kg/h in the group without bleeding complication group (P = .01). Cardiac patients experienced more bleeding complications (P = .01). Multivariate analysis indicated that dose of tPA (P = .01) and diagnostic category (P < .01) were associated with bleeding complication. Complete thrombus resolution occurred in 21 patients, partial in 10 patients, and no resolution in 15 patients. Complete resolution of thrombus was not associated with diagnosis, thrombus location, tPA dose, or duration.
  
  
  CONCLUSIONS
  Cardiac patients appear to be at highest risk of bleeding complication; bleeding complications were associated with higher doses of tPA, and cardiac patients were the cohort who received the highest doses of tPA. Higher tPA doses are associated with increased risk of bleeding complication but are not associated with successful thrombus resolution.
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
authors.forename: Deidra A
authors.initials: DA
authors.lastname: Ansah
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Division of Pediatric Hematology, Oncology, and Bone Marrow Transplantation, Emory University School of Medicine, Atlanta, GA; Aflac Cancer and Blood Disorders Center, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Kavita N
authors.initials: KN
authors.lastname: Patel
authors.affiliation: Children's Healthcare of Atlanta, Atlanta, GA.
authors.forename: Leticia
authors.initials: L
authors.lastname: Montegna
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA; Sibley Heart Center Cardiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: George T
authors.initials: GT
authors.lastname: Nicholson
authors.affiliation: Sibley Heart Center Cardiology, Emory University School of Medicine, Atlanta, GA.
authors.forename: Alexandra C
authors.initials: AC
authors.lastname: Ehrlich
authors.affiliation: Department of Pediatrics, Emory University School of Medicine, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA; Sibley Heart Center Cardiology, Emory University School of Medicine, Atlanta, GA. Electronic address: cjpetit@emory.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Petit
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006333:Heart Failure / Q000151:congenital / Q000628:therapy; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000379:methods; D013927:Thrombosis / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator