Combination Thrombolytic and Anticoagulant Therapy for Bilateral Renal Vein Thrombosis in a Premature Infant

Nancy Weinschenk; Maria Pelidis; John Fiascone

doi:10.1055/s-2001-16993

American Journal of Perinatology, Table of Contents

Am J Perinatol 2001; 18(5): 293-298
DOI: 10.1055/s-2001-16993

ORIGINAL ARTICLES

Combination Thrombolytic and Anticoagulant Therapy for Bilateral Renal Vein Thrombosis in a Premature Infant

Nancy Weinschenk¹ , Maria Pelidis² , John Fiascone¹

¹Division of Newborn Medicine, Department of Pediatrics, Floating Hospital for Children, Tufts University School of Medicine, Boston, Massachusetts
²Division of Hematology and Oncology, Department of Pediatrics, Floating Hospital for Children, Tufts University School of Medicine, Boston, Massachusetts

Abstract

ABSTRACT

We report a premature infant with bilateral renal vein thrombosis and renal failure at 1 month of age who underwent treatment with recombinant tissue plasminogen activator and heparin sulfate. Combination thrombolytic and anticoagulation therapy was complicated by an intraventricular and intraparenchymal cerebral hemorrhage without resolution of the renal vein thrombosis. With increasing reports of successful use of this therapy for venous thrombosis, we suggest caution and continued study of its use in the premature infant and newborn.

KEYWORD

Renal vein thrombosis - TPA - prematurity - intraventricular hemorrhage

Full Text

References

REFERENCES

1 Nowak-Gottl U, Schwabe D, Schneider W, Schlosser R, Kreuz W. Thrombolysis with recombinant tissue-type plasminogen activator in renal vein thrombosis in infancy [letter]. Lancet . 1992; 340 1105
2 Dillon P W, Fox P S, Berg C J, Cardella J F, Krummel T M. Recombinant tissue plasminogen activator for neonatal and pediatric vascular thrombolytic therapy. J Pediatr Surg . 1993; 1264-1269
3 Ries M, Singer H, Hofbeck M. Thrombolysis of a modified Blalock-Taussig shunt with recombinant tissue plasminogen activator in a newborn infant with pulmonary atresia and ventricular septal defect. Br Heart J . 1994; 72 201-202
4 Zenz W, Arlt F, Sodia S, Berghold A. Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the literature of the last thirty years. Semin Thromb Hemost . 1997; 23 321-332
5 Kandler C, Ries M, Rupprecht T, Ruder H, Harms D. Successful systemic low-dose lysis of a caval thrombus by rt-PA in a neonate with congenital nephrotic syndrome. J Pediatr Hematol Oncol . 1997; 19 348-350
6 Seibold-Weiger K, Vochem M, Mackensen-Haen S, Speer C. Fatal hepatic veno-occlusive disease in a newborn infant. Am J Perinatol . 1997; 14 107-111
7 Fleming R E, Barenkamp S J, Jureidini S B. Successful treatment of a Staphylococcus endocarditis vegetation with tissue plasminogen activator. J Pediatr . 1998; 132 535-537
8 Giuffre B, Compagnoni G, Farina C, Mosca F. Successful use of tissue plasminogen activator (t-PA) in catheter-related intracardiac thrombi of two premature infants. Acta Paediatr . 1998; 87 695-698
9 Farnoux C, Camard O, Pinquier D. Recombinant tissue-type plasminogen activator therapy of thrombosis in 16 neonates. J Pediatr . 1998; 133 137-140
10 Chalmers E A, Gibson B ES. Thrombolytic therapy in the management of pediatric thromboembolic disease. Br J Haematol . 1999; 104 14-21
11 Schmidt B. The etiology, diagnosis and treatment of thrombotic disorders in newborn infants: a call for international and multi-institutional studies. Semin Perinatol . 1997; 21 86-89
12 Andrew M, David M, Adams M. Venous thromboembolic events in children: first analyses of the Canadian Registry of VTE. Blood . 1994; 83 1251-1257
13 Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and International Registry. Pediatrics . 1995; 96 939-943
14 Andrew M, Michelson A D, Bouill E, Leaken M, Massicotte M P. Guidelines for antithrombotic therapy in pediatric patients. J Pediatr . 1998; 132 575-588
15 Andrew M, Brooker L A. Hemostatic complications in renal disorders of the young. Pediatr Nephrol . 1996; 10 88-99
16 O'Neill J A. Pediatric Surgery. 5th ed. Philadelphia: Mosby 1998: 1619-1620
17 Manco-Johnson M J, Nuss R, Hays T, Krupski W, Druse J, Manco-Johnson M L. Combined thrombolytic and anticoagulant therapy for venous thrombosis in children. J Pediatr . 2000; 136 446-453
18 Christensen R D. Hematologic Problems of the Neonate. 1st ed. Philadelphia: WB Saunders 1999: 239-271
19 Hathaway W E. Safety of heparin use in the premature infant. J Pediatr . 1997; 131 337-338
20 Streif W, Andrew M. Venous thromboembolic events in pediatric patients. Hemato Oncol Clin North Am . 1998; 12 1283-1312