PB0259 - Thrombolytic therapy in neonates and children: a twelve-year prospective registry of a single tertiary pediatric center in Argentina.

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Carolina Cervio, MD

Pediatric Hematologist
Hospital de Pediatría "Prof. Dr. Juan P. Garrahan"
Buenos Aires, Buenos Aires, Argentina

Co-Author(s)

MH

Mirta D. Hepner

biochemist staff
Hospital de Pediatría "Prof. Dr. J.P.Garrahan"
CABA, Ciudad Autonoma de Buenos Aires, Argentina
BB

Belén B. Bianco

Pediatric Hematologist
Hospital de Pediatría "Prof. Dr. J.P.Garrahan"
CABA, Ciudad Autonoma de Buenos Aires, Argentina
RE

Rocío Escobar

Pediatric hematologist
Servicio de Hematología y Oncología. Hospital de Pediatría Prof Dr JP Garrahan
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
GP

Graciela Pieroni

Biochemist
Laboratorio de Hemostasia y Trombosis. Servicio de Hematología y Oncología. Hospital de Pediatría Prof Dr Juan P Garrahan
Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
Eliana S. Annetta, Biochemist

Biochemist staff
Hospital de Pediatría "Prof. Dr. J.P.Garrahan"
CABA, Ciudad Autonoma de Buenos Aires, Argentina
Juan P. Frontroth, Biochemist

biochemist staff
Hospital de Pediatría "Prof. Dr. J.P.Garrahan"
CABA, Ciudad Autonoma de Buenos Aires, Argentina
GS

Gabriela B. Sciuccati, MD

Pediatric Hematologist
Hospital de Pediatría "Prof. Dr. J.P.Garrahan"
CABA, Ciudad Autonoma de Buenos Aires, Argentina

Background: Thrombolytic therapy(TT) indications are limited to acute or subacute occlusive organ- limb- or life-threatening thrombosis. Thorough case-by-case patient selection is warranted and there is no agreement on the optimal TT regimen in children.

Aims: To describe clinical characteristics, management and outcomes of neonates and children treated with TT at a single tertiary pediatric center.
To describe patients´ characteristics according to clot resolution.

Methods: Jan/2010-Dec/2021, consecutive children < 18 years old with organ- limb- or life-threatening non-stroke venous or arterial thrombosis treated with TT were registered. Demographic and clinical data, treatment and outcomes were prospectively collected. Results are expressed as: median(range).
Protocol: systemic rtPA, 0.1-0.5mg/kg/hr for 6hours, 1-6days; infants < 6 months of age received fresh frozen plasma transfusion before each rtPA infusion; heparin was indicated in-between rtPA doses. Complete, partial or no clot resolution was daily evaluated with imaging methods. Bleeding was classified following the ISTH bleeding scale.

Results: 40pts received rtPA, 25(62.5%)males, age:3.5 months(11days-17.9years). Four patients presented with an unprovoked thrombosis, of whom 2 were diagnosed with hereditary antithrombin deficiency during follow-up. Mean dose of rtPA was 0.3mg/kg/h(0.1-0.5mg/kg/h) and treatment duration, 2days(1-6days). Lag time from diagnosis to TT was 2 days(6hs-34 days): < 14days in 34pts. All-cause mortality, 12pts(30%); death attributable to thrombosis, 3/12pts. There was no mortality due to TT. Patients´ characteristics, TT indications and outcomes are depicted in Table1. Clot resolution was observed in 26/40pts (65%,CI95%:50.2-79.8%): 11/14(78,6%,CI95%:57.1-100%) neonates and 15/26(57,7%,CI95%:38.7-76.7%) children. Patients´ characteristics according to clot resolution is shown in Table2.

Conclusion(s): In this pediatric registry, most patients achieved successful clot resolution with a low bleeding rate. No differences were observed in the variables analyzed between patients who achieved recanalization versus those who did not, probably due to the limitation of the sample size. Thrombolytic agents could be considered in patients with high-risk thrombosis to improve outcomes.