Thrombolytic Therapy for Catheter related venous Thromboses in Infants Dr Osama Bawazir FRCSI, FRCS(Ed), FRCS (glas), FRCSC.

Introduction Venous thrombosis is a rare disorder in children, with few studies reported in the literature. annual incidence of symptomatic VTE in either the lower or upper extremity in children (aged 1 month to 18 years) of 0.07 per 10,000 children and 5.3 per 10,000 hospital admissions. More than one third of all thrombotic events were associated with central venous catheters.

it may be difficult to detect the thrombus formation and it has been shown that many “silent thrombi” Compared with older children, neonates and young infants are more predisposed to thrombosis, because they seem to have a deficiency of thrombin inhibition and relatively deficient fibrinolysis Thrombolytic therapy caused bleeding complications in about 25% In adult Intracranial bleeding incidence 0.42% to 0.95%.

Case 6 month old boy Hx of histiocytosis X 2 month after port-a-cath insertion Present with irritability, left arm swelling and dusky discoloration. Doppler US show thrombosis of left subclavian,axillary and brachial vein with no flow

Heparin started Strptokinas start with bolus of 2000 u/kg then 1000u/kg/hr for 24 hours Clinically the swelling decrease dramatically and capillary refill become normal. US (2 days latter)  re-canalization with some flow int L subclavin vein

LMWH use for 4 weeks Catheter remove and another was inserted in the other site 3 weeks latter. US(4W )  patent subclavian & axillary vein no evidence of DVT

Conclusion Thrombolytic therapy is effective in the thrombolysis of catheter related thrombus in children. Thrombolytic therapy may prevent long term complication of DVT e.g. post-phlebitic syndrom, impaired limb growth and future impairment of vascular access. Thrombolytic therapy should be use only if there is a critical compromise of organs or limbs

Conclusion Thrombolytic therapy should be used with extreme caution in the neonatal period Further study need to document safety and risk–benefit ratio.

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