Local intravenous fibrinolysis in children and adolescents

Czech version

Authors: I. Hofírek ¹; M. Penka ²; M. Zvarová ³; S. Šárník ¹; J. Blatný ²; O. Zapletal ²; J. Rotnágl ¹; O. Sochor ¹
Authors‘ workplace: I. interní kardio‑angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC ¹; Oddělení klinické hematologie FN Brno, pracoviště Bohunice a pracoviště FDN J. G. Mendla, přednosta prof. MUDr. Miroslav Penka, CSc. ²; Oddělení klinické hematologie FN u sv. Anny Brno, přednostka prim. MUDr. Anna Zvarová ³
Published in: Vnitř Lék 2010; 56(Supplementum 1): 58-63
Category: 16th Parizek's Days, Ostrava-Poruba, March 25th –26th 2010

Overview

The paper provides an evaluation of success factors and fibrinolytic dose regimes in adolescents and children whose deep vein thrombosis was managed with local ultrasound-enhanced fibrinolysis. It discusses factors determining success of fibrinolysis and reviews fibrinolytic dosing as well as plasma levels of the main monitored parameters (D-dimer and fibrinogen). The main risk factors associated with the development of deep vein thrombosis in a series of 15 cases included oral contraception use and the presence of genetic predisposition for thrombophilia. Success of thrombolysis did not depend on the duration of administration or a dose of a fibrinolytic agent but it was significantly more successful in individuals with shorter duration of thrombotic symptoms (anamnesis of approximately a week). Dosing of a fibrinolytic was better decided based on a trend in fibrinogen rather than D-dimer plasma levels. Together with fibrinolysis, continual IV low molecular weight heparin was routinely administered. Careful and supervised administration of a fibrinolytic decreases a risk of bleeding complications. Ultrasound-enhanced fibrinolysis alone is feasible in children and adolescents. The procedure is more successful in patients with short (approximately one week) history of symptoms.

Key words:
deep vein thrombosis – local fibrinolysis – duplex sonography

Sources

1. Michelson AD, Bovill E, Andrew M. Antithrombotic therapy in children. Chest 1995; 108: 506S– 522S.

2. Vávrová M, Procházka V, Czerný D et al. May- Thurnerův syndrom v dětském věku. Ces Radiol 2007; 61: 427– 430.

3. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP et al. The Venous Thrombotic Risk of Oral Contraceptives, Effects of Oestrogen Dose and Progestogen Type: Results of the MEGA Case- control Study. BMJ 2009; 339: b2921.

4. Karetová D. Flebotrombóza, tromboembolická nemoc. In: Karetová D, Staněk F et al. Angiologie pro praxi. Praha: Maxdorf 2007: 210– 250.

5. Carter CJ. The natural history and epidemiology of venous thrombosis. Prog Cardiovasc Dis 1994; 36: 423– 438.

6. Watson L, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD002783.

7. Snow V, Qaseem A, Barry P et al. Management of Venous Thromboembolism: A Clinical Practice Guideline from the American College of Physicians and the American Academy of Family Physicians. Ann Fam Med 2007; 5: 74– 80.

8. Roztočil K, Roček M. Léčba žilní trombózy. In: Widimský J, Malý J et al. Akutní plicní embolie a žilní trombóza. Praha: Triton 2005: 277– 288.

9. Hammer R, Harper DAT, Ryan PD. Paleontological Statistics Software Package for Education and Data Analysis. Palaeontologia Electronica 2001; 4: 9.

10. Comerota AJ, Throm RC, Mathias SD et al. Catheter- directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg 2000; 32: 130– 137.

11. Manco- Johnson MJ, Knapp- Clevenger R,Miller B et al. Post-thrombotic syndrome (PTS) in children: validation of a new pediatric outcome instrument and results in a comprehensive cohort of children with extremity deep vein thrombosis (DVT). Blood 2003; 102: 553a.

12. Alesh I, Kayali F, Stein PD. Catheter- directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review. Catheter Cardiovasc Interv 2007; 70: 143– 148.

13. Manco- Johnson MJ, Nuss R, Hays T et al. Combined thrombolytic and anticoagulant therapy for venous thrombosis in children. J Pediatr 2000; 136: 446– 453.

14. Wang M, Hays T, Balasa V et al. Low--dose tissue plasminogen activator thrombolysis in children. J Pediatr Hematol Oncol 2003; 25: 379– 386.