Local intravenous fibrinolysis in children and adolescents

Česká verzia

Authors: I. Hofírek ¹; M. Penka ²; M. Zvarová ³; S. Šárník ¹; J. Blatný ²; O. Zapletal ²; J. Rotnágl ¹ ; O. Sochor ¹
Authors place of work: I. interní kardio‑angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC ¹; Oddělení klinické hematologie FN Brno, pracoviště Bohunice a pracoviště FDN J. G. Mendla, přednosta prof. MUDr. Miroslav Penka, CSc. ²; Oddělení klinické hematologie FN u sv. Anny Brno, přednostka prim. MUDr. Anna Zvarová ³
Published in the journal: Vnitř Lék 2010; 56(Supplementum 1): 58-63
Category: 16th Parizek's Days, Ostrava-Poruba, March 25th –26th 2010

Summary

The paper provides an evaluation of success factors and fibrinolytic dose regimes in adolescents and children whose deep vein thrombosis was managed with local ultrasound-enhanced fibrinolysis. It discusses factors determining success of fibrinolysis and reviews fibrinolytic dosing as well as plasma levels of the main monitored parameters (D-dimer and fibrinogen). The main risk factors associated with the development of deep vein thrombosis in a series of 15 cases included oral contraception use and the presence of genetic predisposition for thrombophilia. Success of thrombolysis did not depend on the duration of administration or a dose of a fibrinolytic agent but it was significantly more successful in individuals with shorter duration of thrombotic symptoms (anamnesis of approximately a week). Dosing of a fibrinolytic was better decided based on a trend in fibrinogen rather than D-dimer plasma levels. Together with fibrinolysis, continual IV low molecular weight heparin was routinely administered. Careful and supervised administration of a fibrinolytic decreases a risk of bleeding complications. Ultrasound-enhanced fibrinolysis alone is feasible in children and adolescents. The procedure is more successful in patients with short (approximately one week) history of symptoms.

Key words:
deep vein thrombosis – local fibrinolysis – duplex sonography

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