BACKGROUND AND OBJECTIVE: Recent surgery (<or=10 days) is considered an absolute contraindication for thrombolytic therapy. We report the successful use of low doses of urokinase locally infused to dissolve an intravascular thrombosis in the early postoperative period after congenital heart surgery. PATIENTS: Two children, with catheter-related intravascular thrombosis after cardiac surgery, received urokinase treatment within 24 hrs and 6 days of surgery, respectively. SETTING: Tertiary, 11-bed, pediatric intensive care unit. INTERVENTIONS: Urokinase was administered through the catheter close to the site of thrombosis with a bolus of 4400 units/kg followed by a continuous infusion of 1300 units x kg(-1) x hr(-1). MAIN RESULTS: Thrombosis resolved completely in both patients after 3 days of therapy. Signs of systemic thrombolysis were not observed. CONCLUSIONS: A short course of local low-dose urokinase is feasible and seems to be effective for thrombolysis of catheter-related thrombosis early after cardiothoracic surgery. It was not associated with bleeding in the two cases presented. Further studies are required to confirm the safety of this approach and to define optimal dosing.
BACKGROUND AND OBJECTIVE: Recent surgery (<or=10 days) is considered an absolute contraindication for thrombolytic therapy. We report the successful use of low doses of urokinase locally infused to dissolve an intravascular thrombosis in the early postoperative period after congenital heart surgery. PATIENTS: Two children, with catheter-related intravascular thrombosis after cardiac surgery, received urokinase treatment within 24 hrs and 6 days of surgery, respectively. SETTING: Tertiary, 11-bed, pediatric intensive care unit. INTERVENTIONS: Urokinase was administered through the catheter close to the site of thrombosis with a bolus of 4400 units/kg followed by a continuous infusion of 1300 units x kg(-1) x hr(-1). MAIN RESULTS:Thrombosis resolved completely in both patients after 3 days of therapy. Signs of systemic thrombolysis were not observed. CONCLUSIONS: A short course of local low-dose urokinase is feasible and seems to be effective for thrombolysis of catheter-related thrombosis early after cardiothoracic surgery. It was not associated with bleeding in the two cases presented. Further studies are required to confirm the safety of this approach and to define optimal dosing.