Thrombolytic agents for arterial and venous thromboses in neonates

Major blood clots are infrequent, but serious complications that can occur in neonatal intensive care. Most often, blood clots are related to catheters (thin tubes inserted into the body), especially those inserted into the torso, for instance umbilical catheters. These are used in treating or monitoring sick newborn babies. Sometimes blood clots do not cause symptoms, but symptomatic blood clots can impair circulation and result in damage in the arms, legs, lungs, kidneys, heart, brain or intestines. The most common treatments are observation (no treatment), anti-clotting drugs (heparin), or clot-dissolving drugs (streptokinase, urokinase, and TPA). Surgery is also sometimes done. Administration of clot-dissolving drugs (thrombolytics) has a risk of causing severe bleeding. It is important to understand which treatment of blood clots produces the best short-term and long-term results. However, a search of the medical literature found no randomized clinical trials that compared clot-dissolving drugs with other blood clot treatments in newborns. Thus, no conclusions could be drawn.

Authors' conclusions: 

No conclusions could be made as no eligible studies were found. It is time that a randomised controlled trial was performed comparing thrombolytic therapy to heparin therapy to aid neonatologists in the treatment of arterial and venous thromboses.

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Background: 

Clinically symptomatic thromboses are infrequent but serious complications in infants undergoing intensive care. Most are related to central vascular catheters. Symptomatic thrombosis may cause severe morbidity due to irreversible organ damage and also loss of limbs.

Objectives: 

To assess the efficacy and safety of thrombolytic agents in neonatal arterial and venous thromboses.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2004), MEDLINE (January 1966 to January 2004), EMBASE (January 1980 to January 2004), and CINAHL (January 1982 to January 2004). We also contacted authors of appropriate review articles.

Selection criteria: 

Randomised controlled trials (RCT) and quasi RCT comparing thrombolytic agents with either heparin or observation in neonates with symptomatic neonatal arterial and venous thromboses were included.

Data collection and analysis: 

Two reviewers independently searched for eligible trials. No eligible studies were found even after contacting authors of review articles for details of any unpublished trials.

Main results: 

No randomised controlled trials (RCT) or quasi-RCT were found.

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