Use of tissue plasminogen activator to treat intracardiac thrombosis in extremely low-birth-weight infants.

OBJECTIVE

Intracardiac thrombosis is a life-threatening complication of extreme prematurity. We describe the use of tissue plasminogen activator to treat intracardiac thrombosis in extremely low-birth-weight preterm infants.

DESIGN

Case series, literature review, and practice guideline for recombinant tissue plasminogen activator treatment of intracardiac thrombosis in extremely low-birth-weight preterm infants.

SETTING

Neonatal intensive care.

PATIENTS

Four extremely low-birth-weight preterm infants coincidentally diagnosed with intracardiac thrombosis during neonatal intensive care.

INTERVENTIONS

Recombinant tissue plasminogen activator in a starting dose of 20 μg/kg/hr, increasing to 200-400 μg/kg/hr, infused for 2-6 days.

MEASUREMENTS AND MAIN RESULTS

Thrombolytic therapy with recombinant tissue plasminogen activator helped achieve rapid clot resolution in all infants and none had any major hemorrhagic complication associated with treatment.

CONCLUSIONS

Tissue plasminogen activator may safely be used to treat intracardiac thrombosis in extremely low-birth-weight preterm infants. Close monitoring of therapy is imperative. Further data are required to confirm the safety of tissue plasminogen activator in preterm infants.