Combined thrombolytic and anticoagulant therapy for venous thrombosis in children

J Pediatr. 2000 Apr;136(4):446-53. doi: 10.1016/s0022-3476(00)90006-4.


Objectives: To evaluate safety, efficacy, and outcome after combination thrombolytic and anticoagulant therapy.

Study design: An open nonrandomized clinical protocol with prospective standardized monitoring and data collection. Children with a documented first episode of deep vein thrombosis were treated with urokinase 4400 U/kg load and per hour with unfractionated heparin at 10 U/kg/h. At 48 hours heparin infusions were increased to achieve a therapeutic level for 5 days. Children were given therapeutic warfarin for at least 3 months. Outcome was assessed at 48 hours and > or =1 year with history, physical examination, high-resolution imaging, and Doppler ultrasonography +/- impedance and photo plethysmography.

Results: Thirty-two children were treated. There was 1 thrombotic death, 1 nonfatal thrombus progression, and 1 pulmonary embolism. At 48 hours half of the children showed substantial clot lysis, and on follow-up these children had complete resolution and had no symptoms. Three children with poor early clot lysis had recurrent thromboemboli, pulmonary embolism, or both, 2 had limb pain and swelling, and 2 had asymptomatic swelling. Two children had minor bleeding, whereas systemic reactions were common.

Conclusions: Combination therapy in children (urokinase and unfractionated heparin) was safe and efficacious. A prospective, randomized, controlled study in children is needed.

Publication types

  • Clinical Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Child
  • Child, Preschool
  • Drug Therapy, Combination
  • Female
  • Fibrinolytic Agents / adverse effects
  • Fibrinolytic Agents / therapeutic use*
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Plethysmography / methods
  • Prospective Studies
  • Pulmonary Embolism / blood
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / drug therapy
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / statistics & numerical data
  • Treatment Outcome
  • Ultrasonography
  • Venous Thrombosis / blood
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / drug therapy*


  • Anticoagulants
  • Fibrinolytic Agents