• Jayanti Bose and Paul Clarke.
• Norfolk & Norwich University Hospital, Norwich, UK.
• Pediatr Crit Care Me. 2011 Nov 1;12(6):e407-9.

ObjectiveIntracardiac thrombosis is a life-threatening complication of extreme prematurity. We describe the use of tissue plasminogen activator to treat intracardiac thrombosis in extremely low-birth-weight preterm infants.DesignCase series, literature review, and practice guideline for recombinant tissue plasminogen activator treatment of intracardiac thrombosis in extremely low-birth-weight preterm infants.SettingNeonatal intensive care.PatientsFour extremely low-birth-weight preterm infants coincidentally diagnosed with intracardiac thrombosis during neonatal intensive care.InterventionsRecombinant tissue plasminogen activator in a starting dose of 20 μg/kg/hr, increasing to 200-400 μg/kg/hr, infused for 2-6 days.Measurements And Main ResultsThrombolytic therapy with recombinant tissue plasminogen activator helped achieve rapid clot resolution in all infants and none had any major hemorrhagic complication associated with treatment.ConclusionsTissue plasminogen activator may safely be used to treat intracardiac thrombosis in extremely low-birth-weight preterm infants. Close monitoring of therapy is imperative. Further data are required to confirm the safety of tissue plasminogen activator in preterm infants.

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