Initial Experience with Tissue Plasminogen Activator in Two Pediatric Oncology Patients

Abstract

With the more frequent use of central venous catheters in children for therapeutic interventions such as the administration of chemotherapy and total parenteral nutrition, there has been an increased recognition of thrombotic complications including thrombotic occlusion, deep venous thrombosis, and superior vena cava syndrome. In the symptomatic child, treatment may be warranted to prevent the sequelae of venous thrombosis including embolic phenomena, secondary bacterial infection, as well as post-thrombotic changes in an extremity. One option for treatment is the use of a thrombolytic agent such as tissue plasminogen activator (TPA). The authors present two children who developed thrombotic complications of central venous devices. TPA successfully resolved the clot and reversed the clinical signs and symptoms of venous obstruction. The literature concerning the use of TPA in pediatric patients, its application in such situations, adverse affects, and dosing regimens are presented.