Combined thrombolytic and anticoagulant therapy for venous thrombosis in children

Objectives: To evaluate safety, efficacy, and outcome after combination thrombolytic and anticoagulant therapy. Study design: An open nonrandom;zed clinical protocol with prospective standardized monitoring and data collection. Children with a documented first episode of deep vein thrombosis were treated with urokinase 4400 U/kg load and per hour with unfractionated heparin at 10 U/kg/h. At 48 hours heparin infusions were increased to achieve a therapeutic level for 5 days. Children were given therapeutic warfarin for at least 3 months. Outcome was assessed at 48 hours and greater than or equal to 1 year with history physical examination, high-resolution imaging, and Doppler ultrasonography r impedance and photo plethysmography. Results: Thirty-two children were treated. There was 1 thrombotic death, 1 nonfatal thrombus progression, and 1 pulmonary embolism. At 48 hours half of the children showed substantial clot lysis, and on follow-up these children had complete resolution and had no symptoms. Three children with poor early clot lysis had recurrent thromboemboli, pulmonary embolism, or both, 2 had limb pain and swelling, and 2 had asymptomatic swelling. TWO Children had minor bleeding, whereas systemic reactions were common. Conclusions: Combination therapy in children (urokinase and unfractionated heparin) was safe and efficacious. A prospective, randomized, controlled study in children is needed.