Compared to standard anti-coagulant therapy, a thrombolytic regimen for high-risk deep venous thrombosis (DVT) may substantially reduce the risk of post-thrombotic syndrome in children.
In the July 1st issue of
Blood, Dr. Neil A. Goldenberg of the University of Colorado at Denver Health and Sciences Center, and colleagues note that although DVT is much less common in children than in adults, in recent decades it has emerged as an important issue in pediatrics.
To gain further information on the matter, the researchers conducted a retrospective review of 22 children who had occlusive DVT of the proximal lower extremity. All had elevated plasma factor VIII activity and/or D-dimer concentration at diagnosis.
Nine children underwent an anti-thrombolytic regimen, typically involving systemic low-dose continuous intravenous infusion of tissue plasminogen activator (tPA) and using local mechanical thrombectomy with catheter-directed tPA administration as salvage therapy for persistent thrombosis.
The remaining patients received conventional treatment, consisting of primary catheter-directed administration of tPA with mechanical thrombectomy via an interventional radiologic approach.
At 18 to 24 months later, 22.2 per cent of those who underwent the thrombolysis regimen developed post-thrombotic syndrome, compared to 76.9 per cent of those given standard treatment (p = 0.01).
Given these encouraging findings, Dr. Goldenberg told Reuters Health that his group now "intends to conduct a multicenter clinical trial of thrombolysis in children with high-risk, acute lower-extremity deep venous thrombosis.
