Superior vena cava thrombus treated with low-dose, peripherally administered recombinant tissue plasminogen activator in a child: case report and review of the literature.

Thrombotic complications in pediatrics are more common today due to our ability to treat complicated diseases. In pediatric patients where thrombolytic therapy is indicated, the lack of evidence-based medicine forces practitioners to extrapolate dose recommendations for recombinant tissue plasminogen activator (rt-PA) from adult studies. This often results in a high rate of major complications. Low-dose rt-PA is an option that is effective and safe. The authors describe a child with septic thrombus of the superior vena cava who was successfully treated with low-dose, peripherally administered rt-PA, and review the efficacy and safety of standard- versus low-dose rt-PA in children. A Medline search was completed for the use of standard- and low-dose rt-PA in children with thromboembolic disease. Five studies large enough to present efficacy and safety data on standard- and/or low-dose t-PA use in children and neonates were analyzed. Two studies using low-dose rt-PA reported efficacy rates equal to or greater than those reported for standard-dose regimens. Rates of major complications were approximately 5% for low-dose regimens and up to 40% for standard-dose ones. Low-dose, peripherally administered rt-PA is safe and may be as effective as standard-dose rt-PA. A randomized controlled trial should be done to confirm this assumption.