SUCCESSFUL SYSTEMIC LOW-DOSE LYSIS OF A CAVAL THROMBUS BY RT-PA IN A NEONATE WITH CONGENITAL NEPHROTIC SYNDROME

Purpose: Thrombotic complications in nephrotic syndrome due to renal l oss of antithrombin III (AT III) are well known. With this case report , we want to demonstrate the possibility of achieving the lysis of suc h a thrombosis in the neonatal period with low-dose rt-PA. Patients an d Methods: We treated a 10-day-old newborn who had congenital nephroti c syndrome, who developed a caval thrombosis during the first days of his life. After a trial of heparin (up to 20 IU/kg/hour) over a period of 24 hours and treatment with AT III (2 x 250 IU/day) proved to be i neffective, we started systemic thrombolytic therapy with rt-PA. An in itial bolus of 0.4 mg/kg during 1 hour was followed by an infusion of 0.5 mg/kg/d rt-PA over a period of 36 hours. Low-dose heparin (5 IU/kg /hour) was given simultaneously. Complete clot dissolution could be ac hieved this way. No adverse effects were observed, including no clinic al signs of bleeding. Conclusion: It seems that low-dose rt-PA treatme nt is safe and effective in dissoluting large caval thromboses in neon ates.