USE OF TISSUE-TYPE PLASMINOGEN-ACTIVATOR IN NEONATES - CASE-REPORTS AND REVIEW OF THE LITERATURE

Recombinant tissue type plasminogen activator (rt-PA) has been used su ccessfully in neonates for resolution of thrombotic processes, both ar terial and venous. We report on 2 neonates with vena cava inferior thr ombosis and with biochemical evidence of liver dysfunction in whom rt- PA treatment had to be interrupted because of significant bleeding ten dency, without complete resolution of the thrombus. Therapy failure ma y be due to the age of the thrombus and the systemic way of administra tion, bypassing the site of the thrombus by collateral circulation. Im paired liver function may result in decreased degradation of rt-PA wit h prolonged effect and higher risk for bleeding complications. We sugg est that lower doses should be administered in these patients.