SYSTEMIC AND LOCAL THROMBOLYTIC THERAPY W ITH RT-PA (ACTILYSE(R)) IN CHILDREN WITH CONGENITAL HEART-DISEASE

Background: We report our experience with the local and systemic appli cation of recombinant tissue plasminogen activator (rt-PA) in 6 childr en aged 11 months-11 7/12 years suffering from various thromboembolic states including left atrial thrombus with prosthesis dysfunction, thr ombosed femoral artery after cardiac catherization and thrombosed modi fied Blalock-Taussig-shunts. Method: Systemic thrombolytic therapy was started with 0.5 mg/kg rt-PA as a slow bolus injection over 30 min fo llowed by an infusion of 0.5 mg/kg/day for 2 or 3 days. One child was successfully treated with a dosage of 0.3 mg/kg/day for 3 days without bolus injection. For local thrombolytic therapy into the aortopulmona ry shunts rt-PA was applicated in 4 single doses of 0.2 mg/kg in 1 pat ient and 0.1 mg/kg in the other. Results: Complete clot dissolution an d clinical improvement occurred in 5 children. A bleeding complication was noted in one of the 6 patients and controlled by infusion of eryt hrocyte concentrate. Conclusion: We conclude that recombinant tissue p lasminogen activator is effective in inducing clot lysis and a good al ternative to therapy with urokinase, streptokinase or surgical treatme nt.