Vnitr Lek 2010, 56(Suppl 1):58-63

Local intravenous fibrinolysis in children and adolescents

I. Hofírek^1,*, M. Penka², M. Zvarová³, S. Šárník¹, J. Blatný², O. Zapletal², J. Rotnágl¹, O. Sochor¹

¹ I. interní kardio-angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednosta prof. MUDr. Jiří Vítovec, CSc., FESC

² Oddělení klinické hematologie FN Brno, pracoviště Bohunice a pracoviště FDN J. G. Mendla, přednosta prof. MUDr. Miroslav Penka, CSc.

³ Oddělení klinické hematologie FN u sv. Anny Brno, přednostka prim. MUDr. Anna Zvarová

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.

Keywords: deep vein thrombosis; local fibrinolysis; duplex sonography

Received: April 16, 2010; Published: February 1, 2010  Show citation