Gupta A A, Leaker M, Andrew M, Massicotte P, Liu L, Benson L N, McCrindle B W
Division of Cardiology, The University of Toronto, Toronto, Ontario, Canada.
J Pediatr. 2001 Nov;139(5):682-8. doi: 10.1067/mpd.2001.118428.
In this study, we tried to determine the safety and outcomes of thrombolysis with tissue plasminogen activator of intravascular thrombus.
Eighty consecutive children were treated between 1985 and 1999 in a tertiary care setting in a retrospective case series. There were 65 arterial thrombi (56 after cardiac catheterization) and 15 venous thrombi treated with tPA at an average dose of tPA of 0.5 mg/kg/hour for a median duration of 6 hours.
Clot resolution was complete in 65% of children, partial in 20%, and there was no effect in 15%. There were major complications in 40%, minor complications in 30%, and no complications in 30%. Two patients had cerebral ischemia secondary to hypotension because of profound bleeding, with intracranial hemorrhage in 2 additional patients. Clot resolution was not related to patient age or weight, dose, and duration of tPA therapy and fibrinogen levels. However, complications were more likely in patients who weighed less, had a longer duration of therapy, a greater decrease in fibrinogen levels, and who failed to have resolution of their clot.
tPA therapy can be effective in the thrombolysis of intravascular thrombus in children, but is associated with a low margin of safety and an unknown risk-benefit ratio.
在本研究中，我们试图确定使用组织型纤溶酶原激活剂进行血管内血栓溶栓治疗的安全性和疗效。
在1985年至1999年期间，一家三级医疗机构对80例连续儿童进行了回顾性病例系列研究。其中65例为动脉血栓（56例发生于心脏导管插入术后），15例为静脉血栓，采用组织型纤溶酶原激活剂治疗，平均剂量为0.5毫克/千克/小时，中位治疗时间为6小时。
65%的儿童血栓完全溶解，20%部分溶解，15%无效果。40%发生严重并发症，30%发生轻微并发症，30%无并发症。2例患者因严重出血导致低血压继发脑缺血，另有2例患者发生颅内出血。血栓溶解与患者年龄、体重、组织型纤溶酶原激活剂治疗剂量和持续时间以及纤维蛋白原水平无关。然而，体重较轻、治疗时间较长、纤维蛋白原水平下降幅度较大且血栓未溶解的患者更易发生并发症。
组织型纤溶酶原激活剂治疗对儿童血管内血栓溶栓可能有效，但安全性较低，风险效益比未知。
