Mondì V, Di Paolo A, Fabiano A, Cicchese M, De Merulis G, Giannini C, Del Principe D
Department of Pediatrics, University of Tor Vergata, Sant Eugenio Hospital, Rome, Italy.
Minerva Pediatr. 2011 Apr;63(2):115-8.
Intracardiac thrombosis is a rare event in newborn (5.1 per 100000 live births). It is associated with an high morbidity and mortality. Most of intracardiac thrombi are related to intravascular catheterism. The use of thrombolytic therapy in neonates has rapidly improved in the last few years, particularly with the introduction of more clot-selective second-generation agents like urokinase and tissue plasminogen activator. In literature there is no therapeutic trial concerning the pharmacological approach of atrial thrombosis in newborns; different approaches are described in the case reports present in literature. In all of them, tissue plasminogen activator or urokinase are alternatively administered. In no case report urokinase and tissue plasminogen activator are administered in a combined thrombolytic therapy. Combined thrombolytic therapy with urokinase and tissue plasminogen activator, in association with low-dose heparin, allows the use of lower drug doses, less therapy's duration and a rapid resolution of thrombus. Thormbolytic therapy is sometimes complicated with hemorrhagic complications. This article describes the case of a preterm infant (25 weeks of gestational age) with peduncolate thrombus in the right atrium, treated with combined thrombolytic therapy. The authors noticed a rapid decrease in thrombus dimension, no thrombus replacement and no organ bleeding.
心内血栓形成在新生儿中是一种罕见事件（每10万例活产中有5.1例）。它与高发病率和死亡率相关。大多数心内血栓与血管内插管有关。在过去几年中，新生儿溶栓治疗迅速发展，特别是随着更具血栓选择性的第二代药物如尿激酶和组织型纤溶酶原激活剂的引入。文献中没有关于新生儿心房血栓形成药物治疗方法的治疗试验；文献中的病例报告描述了不同的方法。在所有这些报告中，交替使用组织型纤溶酶原激活剂或尿激酶。在任何病例报告中，尿激酶和组织型纤溶酶原激活剂都没有联合用于溶栓治疗。尿激酶和组织型纤溶酶原激活剂联合溶栓治疗，联合低剂量肝素，可使用更低的药物剂量、缩短治疗时间并使血栓迅速溶解。溶栓治疗有时会并发出血并发症。本文描述了一名胎龄25周的早产儿右心房有蒂血栓，接受联合溶栓治疗的病例。作者注意到血栓尺寸迅速减小，没有血栓替代现象，也没有器官出血。
