Hemothorax under thrombolytic therapy with recombinant tissue - Plasminogen activator (rt-PA) in a 16-year-old girl

We present the case of a 16-year-old girl with an extended thrombosis of th e femoral and iliac vein and the inferior vena cava during pleuropneumonia; predisposing risk factors for thrombophilia were: use of contraceptives, n icotine abuse and congenital deficiency of antithrombin III (not previously diagnosed). Thrombolytic therapy with recombinant tissue plasminogen activ ator (rt-PA; initial dose: 0.08 mg/kg/h) was started. 2 days later - after diagnosis of an extended hemothorax: 1500 mi blood were obtained after thor acocentesis, transfusion of packed red blood cells was necessary - rt-PA wa s stopped, with only heparin (400 U/kg/d) being administered. 36 h later - the thrombosis had not yet changed - the thrombolytic therapy with rt-PB wa s continued in a markedly reduced dose (0.015 mg/kg/d) with no further blee ding complications. 8 days later - after successful thrombolysis - rt-PA wa s stopped, heparin was given for another 10 days, then cumarin was administ ered orally.