Levy M, Benson L N, Burrows P E, Bentur Y, Strong D K, Smith J, Johnson D, Jacobson S, Koren G
Division of Clinical Pharmacology, Hospital for Sick Children, Toronto, Ontario, Canada.
J Pediatr. 1991 Mar;118(3):467-72. doi: 10.1016/s0022-3476(05)82170-5.
We report our experience with the use of tissue plasminogen activator to treat 12 infants and children with various thromboembolic states after conventional thrombolytic agents had failed. The dosage range was between 0.1 to 0.5 mg/kg per hour. Complete clot dissolution occurred in seven cases after 2 hours to 3 days of therapy. Partial clot dissolution and clinical improvement were noted in another four patients. Bleeding complications were noted in 6 of the 12 patients and included bruising, oozing from various venipuncture sites, and bleeding; these complications were controlled by clinically available means. In all cases with bleeding the dose rate was in the higher range (0.46 to 0.50 mg/kg per hour). In one patient, restlessness, agitation, and screaming were noted during administration of tissue plasminogen activator and when it was reinstituted. We conclude that tissue plasminogen activator is effective in inducing clot lysis in children. Because the effective dose appears to overlap with those causing bleeding, we recommend that a dose of 0.1 mg/kg per hour be started and increased gradually if clot dissolution does not occur, with close monitoring for bleeding.
我们报告了在常规溶栓药物治疗失败后，使用组织型纤溶酶原激活剂治疗12例患有各种血栓栓塞状态的婴幼儿及儿童的经验。剂量范围为每小时0.1至0.5毫克/千克。在治疗2小时至3天后，7例患者的血栓完全溶解。另外4例患者出现部分血栓溶解及临床症状改善。12例患者中有6例出现出血并发症，包括瘀斑、不同静脉穿刺部位渗血及出血；这些并发症通过临床可用方法得到控制。所有出血病例的剂量率均处于较高范围（每小时0.46至0.50毫克/千克）。在1例患者中，在给予组织型纤溶酶原激活剂期间及再次用药时，出现了烦躁、激动和尖叫。我们得出结论，组织型纤溶酶原激活剂在诱导儿童血栓溶解方面是有效的。由于有效剂量似乎与导致出血的剂量有重叠，我们建议开始时每小时给予0.1毫克/千克的剂量，如果未发生血栓溶解则逐渐增加剂量，并密切监测出血情况。
