Initial experience with tissue plasminogen activator in two pediatric oncology patients

With the more frequent use of central venous catheters in children for ther apeutic interventions such as the administration of chemotherapy and total parenteral nutrition, there has been an increased recognition of thrombotic complications including thrombotic occlusion, deep venous thrombosis, and superior vena cava syndrome. In the symptomatic child, treatment may be war ranted to prevent the sequelae of venous thrombosis including embolic pheno mena, secondary bacterial infection, as well as post-thrombotic changes in an extremity One option for treatment is the use of a thrombolytic agent su ch as tissue plasminogen activator (TPA). The authors present two children who developed thrombotic complications of central venous devices. TPA succe ssfully resolved the clot and reversed the clinical signs and symptoms of v enous obstruction. The literature concerning the use of TPA in pediatric pa tients, its application in such situations, adverse affects, and dosing reg imens are presented.