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Efficacy and safety of recombinant tissue plasminogen activator for venous thrombosis after paediatric heart surgery

Published online by Cambridge University Press:  11 September 2017

Lindsey B. Justice ,
David P. Nelson ,
Joseph Palumbo ,
Jaclyn Sawyer ,
Manish N. Patel  and
Jonathan W. Byrnes Open the ORCID record for Jonathan W. Byrnes [Opens in a new window]
Lindsey B. Justice*
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
David P. Nelson
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Joseph Palumbo
Affiliation:
Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Jaclyn Sawyer
Affiliation:
Division of Pharmacy, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Manish N. Patel
Affiliation:
Department of Radiology and Medical Imaging, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
Jonathan W. Byrnes
Affiliation:
The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
*
Correspondence to: B. Justice, DNP, APRN, CPNP-AC, The Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, United States of America. Tel: +513 636 6267; E-mail: [email protected]
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Abstract

Objective

Reports in the literature of treatment with recombinant tissue plasminogen activator following cardiac surgery are limited. We reviewed our experience to provide a case series of the therapeutic use of tissue plasminogen activator for the treatment of venous thrombosis in children after cardiac surgery. The data describe the morbidity, mortality, and clinical outcomes of tissue plasminogen activator administration for treatment of venous thrombosis in children following cardiac surgery.

Design

The study was designed as a retrospective case series.

Setting

The study was carried out in a 25-bed cardiac intensive care unit in an academic, free-standing paediatric hospital.

Patients

All children who received tissue plasminogen activator for venous thrombosis within 60 days of cardiac surgery, a total of 13 patients, were included.

Interventions

Data was collected, collated, and analysed as a part of the interventions of this study.

Measurements and main results

Patients treated with tissue plasminogen activator were principally young infants (median 0.2, IQR 0.07–0.58 years) who had recently (22, IQR 12.5–27.3 days) undergone cardiac surgery. Hospital mortality was high in this patient group (38%), but there was no mortality attributable to tissue plasminogen activator administration, occurring within <72 hours. There was one major haemorrhagic complication that may be attributable to tissue plasminogen activator. Complete or partial resolution of venous thrombosis was confirmed using imaging in 10 of 13 patients (77%), and tissue plasminogen activator administration was associated with resolution of chylous drainage, with no drainage through chest tubes, at 10 days after tissue plasminogen activator treatment in seven of nine patients who had upper-compartment venous thrombosis-associated chylothorax.

Conclusions

On the basis of our experience with administration of tissue plasminogen activator in children after cardiac surgery, tissue plasminogen activator is both safe and effective for resolution of venous thrombosis in this high-risk population.

Keywords

Tissue plasminogen activatoralteplasevenous thrombosispaediatriccardiac surgeryoutcomes
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 214 - 221
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Copyright
© Cambridge University Press 2017 

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