Abstract
In a retrospective study all available publications concerning children with thromboembolic
disease and fibrinolytic therapy between January 1, 1964, and June 30, 1995, were
reviewed with regard to the occurrence of intracerebral hemorrhages (ICH). ICH was
found in 14/929 patients analyzed. According to the age when thrombolytic therapy
was performed, ICH was described in 2/468 children after the neonatal period, in 1/83
term infants; and in 11/86 preterm infants; 10/40 preterm infants who were treated
in the first week of life developed ICH.
ICH during thrombolytic therapy in children is reported with the use of streptokinase,
urokinase (UK), UK-activated plasmin, UK and plasminogen, and recombinant tissue plasminogen
activator (rt-PA).
The risk of developing an ICH from thrombolytic therapy seems to be low in children
after the neonatal period and in term infants. Because of the high incidence of “spontaneous”
ICH in preterm infants, it cannot be established whether the more frequently described
ICH in these patients is a complication of thrombolytic therapy.
In the absence of randomized trials this analysis may be helpful for decision making
in children with thromboembolic disorders. However, the data have to be regarded with
caution because of the summation of cases with different thromboembolic disorders,
treatment with different substances in different dosages, and the retrospective study
design that could lead to an underrepresentation of this complication.
Keywords:
fibrinolytic therapy - streptokinese - urokinese - recombinant tissue plasminogen
activitator - thrombolytic therapy - intracerebral hemorrhage - children - infants
- thromboembolism
