Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the literature of the last thirty years

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.