Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study

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dc.authoridYazal Erdem, Arzu/0000-0003-1043-8471
dc.authoridORHAN, Mehmet Fatih/0000-0001-8081-6760
dc.authoridAYLAN GELEN, SEMA/0000-0002-8473-8146
dc.authoridGULEN, HUSEYIN/0000-0002-5374-4957
dc.authoridTUREDI YILDIRIM, AYSEN/0000-0002-4451-5108
dc.contributor.authorZengin, Emine
dc.contributor.authorSarper, Nazan
dc.contributor.authorErdem, Arzu Yazal
dc.contributor.authorAl, Isik Odaman
dc.contributor.authorEvim, Melike Sezgin
dc.contributor.authorYarali, Nese
dc.contributor.authorBelen, Burcu
dc.date.accessioned2025-01-21T16:55:28Z
dc.date.available2025-01-21T16:55:28Z
dc.date.issued2021
dc.departmentKırıkkale Üniversitesi
dc.description.abstractObjective: This study aimed to evaluate systemic thrombolysis experiences with recombinant tissue plasminogen activator (rtPA). Materials and Methods: Retrospective data were collected from 13 Turkish pediatric hematology centers. The dose and duration of rtPA treatment, concomitant anticoagulant treatment, complete clot resolution (CCR), partial clot resolution (PCR), and bleeding complications were evaluated. Low-dose (LD) rtPA treatment was defined as 0.01-0.06 mg/kg/h and high-dose (HD) rtPA as 0.1-0.5 mg/kg/h. Results: Between 2005 and 2019, 55 thrombotic episodes of 54 pediatric patients with a median age of 5 years (range: 1 day to 17.75 years) were evaluated. These patients had intracardiac thrombosis (n=16), deep vein thrombosis (DVT) (n=15), non-stroke arterial thrombosis (n=14), pulmonary thromboembolism (PE) (n=6), and stroke (n=4). The duration from thrombus detection to rtPA initiation was a median of 12 h (range: 2-504 h) and it was significantly longer in cases of DVT and PE compared to stroke, non-stroke arterial thrombosis, and intracardiac thrombosis (p=0.024). In 63.6% of the episodes, heparin was initiated before rtPA treatment. LD and HD rtPA were administered in 22 and 33 of the episodes, respectively. Concomitant anticoagulation was used in 90% and 36% of the episodes with LD and HD rtPA, respectively (p=0.0001). Median total duration of LD and HD rtPA infusions was 30 h (range: 2-120 h) and 18 h (2-120 h), respectively (p=0.044). Non-fatal major and minor bleeding rates were 12.5% and 16.7% for LD and 3.2% and 25.8% for HD rtPA, respectively. At the end of the rtPA infusions, CCR and PCR were achieved in 32.7% and 49.0% of the episodes, respectively. The most successful site for thrombolysis was intracardiac thrombosis. HD versus LD rtPA administration was not correlated with CCR/PCR or bleeding (p>0.05). Conclusion: Systemic thrombolytic therapy may save lives and organs effectively if it is used at the right indications and the right times in children with high-risk thrombosis by experienced hematologists with close monitoring of recanalization and bleeding.
dc.identifier.doi10.4274/tjh.galenos.2021.2021.0038
dc.identifier.endpage305
dc.identifier.issn1300-7777
dc.identifier.issn1308-5263
dc.identifier.issue4
dc.identifier.pmid34431642
dc.identifier.scopus2-s2.0-85122055064
dc.identifier.scopusqualityQ3
dc.identifier.startpage294
dc.identifier.urihttps://doi.org/10.4274/tjh.galenos.2021.2021.0038
dc.identifier.urihttps://hdl.handle.net/20.500.12587/25789
dc.identifier.volume38
dc.identifier.wosWOS:000730491500005
dc.identifier.wosqualityQ4
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherGalenos Yayincilik
dc.relation.ispartofTurkish Journal of Hematology
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_20241229
dc.subjectRecombinant tissue plasminogen activator; Thrombolysis; Childhood thrombosis
dc.titleThrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study
dc.title.alternativeÇocuklarda Sistemik Rekombinant Doku Plazminojen Aktivatörü ile Tromboliz: Çok Merkezli Bir Retrospektif Çalışma
dc.typeArticle

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