Summary
The results of fibrinolytic therapy with urokinase were evaluated in 26 neonates with
catheter related central venous thrombosis. Complete thrombolysis could be achieved
in 13 patients (50%), partial thrombolysis in 3 patients (12%). No effect was seen
in 10 patients (38%). Therapy success was influenced by age, size and location of
the thrombus. Coincidence of infection occurred in 16 patients (62%). Mild hemorrhagic
complications were seen in 2 patients (8%), no other significant side effects were
observed. Nine patients with residual thrombosis were treated with oral anticoagulants
following urokinase resulting in resolution of the thrombus in 6 patients within 3
months (67%). The incidence of asymptomatic recurrent thrombosis was high (28%). Urokinase
might be an effective and safe treatment for central venous thrombosis in neonates.
Prophylactic antibiotic therapy during the infusion of urokinase and long-term treatment
with oral anticoagulants after thrombosis are advisable. Early detection of thrombosis
might enhance the success rate of fibrinolytic therapy. Therefore, we strongly recommend
routine echocardiographic screening of central venous catheters.
