Overview of thrombolytic therapy in neonates

This algorithm summarizes our suggested approach to administering thrombolytic therapy in neonates. Thrombolytic therapy is used infrequently in the management of neonatal thrombosis, but it may be necessary in situations wherein thrombus occludes a major vessel causing critical compromise of organs or limbs. Decisions about thrombolytic therapy in newborns should ideally be made by a multidisciplinary team with input from surgical and hematology specialists. When the decision is made to treat with thrombolytic therapy, tPA (alteplase) is the agent of choice. Refer to UpToDate topic on neonatal thrombosis for additional details, including discussion of indications and contraindications.

CBC: complete blood count; PT: prothrombin time; INR: international normalized ratio; aPTT: activated thromboplastin time; FFP: fresh frozen plasma; tPA: recombinant tissue-type plasminogen activator (alteplase); LMWH: low molecular weight heparin.
* Administering pretreatment FFP supplies the physiologic plasminogen deficiency present in newborns and helps promote fibrinolysis.
¶ Low fibrinogen is treated with cryoprecipitate and/or FFP.
Δ The choice of imaging study depends upon the location of the thrombus. Doppler ultrasound is typically used to assess thrombi in the superior or inferior cava, renal vessels, and extremities; echocardiography is used to assess intracardiac thrombi.
◊ An adquate response to tPA is generally signalled by complete or partial resolution of the thrombus and restoration of blood flow to the affected organ or extremity.

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Overview of thrombolytic therapy in neonates