Thrombolysis with Systemic Recombinant Tissue Plasminogen
Activator in Children: A Multicenter Retrospective Study

Objective: This study aimed to evaluate systemic thrombolysis experiences with recombinant tissue plasminogen activator (rtPA). Materials and Methods: Retrospective data were collected from 13 Turkish pediatric hematology centers. The dose and duration of rtPA treatment, concomitant anticoagulant treatment, complete clot resolution (CCR), partial clot resolution (PCR), and bleeding complications were evaluated. Low-dose (LD) rtPA treatment was defined as 0.01-0.06 mg/kg/h and high-dose (HD) rtPA as 0.1-0.5 mg/kg/h. Results: Between 2005 and 2019, 55 thrombotic episodes of 54 pediatric patients with a median age of 5 years (range: 1 day to 17.75 years) were evaluated. These patients had intracardiac thrombosis (n=16), deep vein thrombosis (DVT) (n=15), non-stroke arterial thrombosis (n=14), pulmonary thromboembolism (PE) (n=6), and stroke (n=4). The duration from thrombus detection to rtPA initiation was a median of 12 h (range: 2-504 h) and it was significantly longer in cases of DVT and PE compared to stroke, non-stroke arterial thrombosis, and intracardiac thrombosis (p=0.024). In 63.6% of the episodes, heparin was initiated before rtPA treatment. LD and HD rtPA were administered in 22 and 33 of the episodes, respectively. Concomitant anticoagulation was used in 90% and 36% of the episodes with LD and HD rtPA, respectively (p=0.0001). Median total duration of LD and HD rtPA infusions was 30 h (range: 2-120 h) and 18 h (2-120 h), respectively (p=0.044). Non-fatal major and minor bleeding rates were 12.5% and 16.7% for LD and 3.2% and 25.8% for HD rtPA, respectively. At the end of the rtPA infusions, CCR and PCR were achieved in 32.7% and 49.0% of the episodes, respectively. The most successful site for thrombolysis was intracardiac thrombosis. HD versus LD rtPA administration was not correlated with CCR/PCR or bleeding (p>0.05). Conclusion: Systemic thrombolytic therapy may save lives and organs effectively if it is used at the right indications and the right times in children with high-risk thrombosis by experienced hematologists with close monitoring of recanalization and bleeding.

Anahtar Kelime:

Çocuklarda Sistemik Rekombinant Doku Plazminojen Aktivatörü ile Tromboliz: Çok Merkezli Bir Retrospektif Çalışma

Öz:

Amaç: Geriye dönük çok merkezli bir çalışma düzenleyerek, çocuk hematoloji uzmanlarının sistemik rekombinant doku plazminojen aktivatörü (rtPA) kullanımı ile ilgili deneyimlerinin ortaya konması amaçlandı Gereç ve Yöntemler: Türkiye’deki 13 pediatrik hematoloji merkezinden geriye dönük veriler toplandı. rtPA tedavisinin dozu ve süresi, eşzamanlı antikoagülan tedavi, tam pıhtı erimesi (TPE), kısmi pıhtı erimesi (KPE) ve kanama komplikasyonları değerlendirildi. Düşük doz (DD) rtPA tedavisi 0,01-0,06 mg/kg/saat ve yüksek doz (YD) 0,1-0,5 mg/kg/saat olarak tanımlandı. Bulgular: 2005-2019 yılları arasında ortanca yaşı 5 yıl (1 gün-17,75 yıl) olan 54 hastanın 55 trombotik epizodu değerlendirildi. Hastaların tanıları; intrakardiyak tromboz (n=16), derin ven trombozu (DVT) (n=15), inme dışı arteriyel tromboz (n=14), pulmoner tromboemboli (PE) (n=6) ve inme (n=4) idi. Trombüs saptanmasından rtPA başlangıcına kadar geçen süre medyan 12 saat (2 sa-504 sa) idi ve inme, inme olmayan arteriyel tromboz ve intrakardiyak tromboza kıyasla DVT ve PE için anlamlı olarak daha uzundu (p=0,024). Atakların %63,6’sında rtPA tedavisinden önce heparin başlandı. Atakların 22’sine DD ve 33’üne YD rtPA uygulandı. DD ve YD rtPA ataklarının sırasıyla %90’ında ve %36’sında eş zamanlı antikoagülasyon kullanıldı (p=0,0001). DD ve YD rtPA infüzyonlarının medyan toplam süresi sırasıyla 30 sa (2 sa- 120 sa) ve 18 sa (2 sa-120 sa) idi (p=0,044). Ölümcül olmayan majör ve minör kanama oranları DD için sırasıyla %12,5, %16,7 ve YD rtPA için %3,2, %25,8 idi. rtPA infüzyonlarının sonunda, atakların sırasıyla %32,7’sinde TPE ve %49’unda KPE elde edildi. Tromboliz için en başarılı bölge intrakardiyak trombozdu. YD’ye karşı DD rtPA uygulaması, TPE/ KPE veya kanama ile korele değildi (p>0,05). Sonuç: Yüksek riskli trombozlu çocuklarda sistemik trombolitik tedavi, deneyimli hematologlar tarafından rekanalizasyon ve kanamanın yakın takibi altında doğru endikasyon ve doğru zamanda kullanıldığında etkin bir şekilde hayat ve organ kurtarabilir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	zengin e, Sarper N, YAZAL ERDEM A, Odaman Al I, EVİM M, Akçay A, TÜREDİ YILDIRIM A, HİLKAY KARAPINAR T, GÜNEŞ A, AYLAN GELEN S, Olcay L, BAYTAN B, GÜLEN H (2021). Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. , 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
Chicago	zengin emine,Sarper Nazan,YAZAL ERDEM Arzu,Odaman Al Işık,EVİM Melike Sezgin,Akçay Arzu,TÜREDİ YILDIRIM Ayşen,HİLKAY KARAPINAR Tuba,GÜNEŞ Adalet Meral,AYLAN GELEN SEMA,Olcay Lale,BAYTAN Birol,GÜLEN Hüseyin Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. (2021): 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
MLA	zengin emine,Sarper Nazan,YAZAL ERDEM Arzu,Odaman Al Işık,EVİM Melike Sezgin,Akçay Arzu,TÜREDİ YILDIRIM Ayşen,HİLKAY KARAPINAR Tuba,GÜNEŞ Adalet Meral,AYLAN GELEN SEMA,Olcay Lale,BAYTAN Birol,GÜLEN Hüseyin Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. , 2021, ss.294 - 305. 10.4274/tjh.galenos.2021.2021.0038
AMA	zengin e,Sarper N,YAZAL ERDEM A,Odaman Al I,EVİM M,Akçay A,TÜREDİ YILDIRIM A,HİLKAY KARAPINAR T,GÜNEŞ A,AYLAN GELEN S,Olcay L,BAYTAN B,GÜLEN H Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. . 2021; 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
Vancouver	zengin e,Sarper N,YAZAL ERDEM A,Odaman Al I,EVİM M,Akçay A,TÜREDİ YILDIRIM A,HİLKAY KARAPINAR T,GÜNEŞ A,AYLAN GELEN S,Olcay L,BAYTAN B,GÜLEN H Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. . 2021; 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
IEEE	zengin e,Sarper N,YAZAL ERDEM A,Odaman Al I,EVİM M,Akçay A,TÜREDİ YILDIRIM A,HİLKAY KARAPINAR T,GÜNEŞ A,AYLAN GELEN S,Olcay L,BAYTAN B,GÜLEN H "Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study." , ss.294 - 305, 2021. 10.4274/tjh.galenos.2021.2021.0038
ISNAD	zengin, emine vd. "Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study". (2021), 294-305. https://doi.org/10.4274/tjh.galenos.2021.2021.0038

APA	zengin e, Sarper N, YAZAL ERDEM A, Odaman Al I, EVİM M, Akçay A, TÜREDİ YILDIRIM A, HİLKAY KARAPINAR T, GÜNEŞ A, AYLAN GELEN S, Olcay L, BAYTAN B, GÜLEN H (2021). Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. Turkish Journal of Hematology, 38(4), 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
Chicago	zengin emine,Sarper Nazan,YAZAL ERDEM Arzu,Odaman Al Işık,EVİM Melike Sezgin,Akçay Arzu,TÜREDİ YILDIRIM Ayşen,HİLKAY KARAPINAR Tuba,GÜNEŞ Adalet Meral,AYLAN GELEN SEMA,Olcay Lale,BAYTAN Birol,GÜLEN Hüseyin Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. Turkish Journal of Hematology 38, no.4 (2021): 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
MLA	zengin emine,Sarper Nazan,YAZAL ERDEM Arzu,Odaman Al Işık,EVİM Melike Sezgin,Akçay Arzu,TÜREDİ YILDIRIM Ayşen,HİLKAY KARAPINAR Tuba,GÜNEŞ Adalet Meral,AYLAN GELEN SEMA,Olcay Lale,BAYTAN Birol,GÜLEN Hüseyin Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. Turkish Journal of Hematology, vol.38, no.4, 2021, ss.294 - 305. 10.4274/tjh.galenos.2021.2021.0038
AMA	zengin e,Sarper N,YAZAL ERDEM A,Odaman Al I,EVİM M,Akçay A,TÜREDİ YILDIRIM A,HİLKAY KARAPINAR T,GÜNEŞ A,AYLAN GELEN S,Olcay L,BAYTAN B,GÜLEN H Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. Turkish Journal of Hematology. 2021; 38(4): 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
Vancouver	zengin e,Sarper N,YAZAL ERDEM A,Odaman Al I,EVİM M,Akçay A,TÜREDİ YILDIRIM A,HİLKAY KARAPINAR T,GÜNEŞ A,AYLAN GELEN S,Olcay L,BAYTAN B,GÜLEN H Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study. Turkish Journal of Hematology. 2021; 38(4): 294 - 305. 10.4274/tjh.galenos.2021.2021.0038
IEEE	zengin e,Sarper N,YAZAL ERDEM A,Odaman Al I,EVİM M,Akçay A,TÜREDİ YILDIRIM A,HİLKAY KARAPINAR T,GÜNEŞ A,AYLAN GELEN S,Olcay L,BAYTAN B,GÜLEN H "Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study." Turkish Journal of Hematology, 38, ss.294 - 305, 2021. 10.4274/tjh.galenos.2021.2021.0038
ISNAD	zengin, emine vd. "Thrombolysis with Systemic Recombinant Tissue Plasminogen Activator in Children: A Multicenter Retrospective Study". Turkish Journal of Hematology 38/4 (2021), 294-305. https://doi.org/10.4274/tjh.galenos.2021.2021.0038