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.