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Thrombolytic agents for arterial and venous thromboses in neonates

  • Review
  • Intervention

Authors


Abstract

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 methods

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 No eligible studies were found even after contacting authors of review articles for details of any unpublished trials.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

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.

摘要

背景

血栓溶解劑在新生兒動靜脈血管栓塞的使用

臨床上新生兒因為血管栓塞而引起症狀的比例並不高,但在接受加護治療的新生兒中卻可能引發嚴重的併發症. 這些狀況大多跟中央動靜脈導管的留置有關.有臨床症狀的栓塞可能會因為對器官造成不可回復的傷害而導致日後的不便,甚至會有失去肢體的可能.

目標

評估血栓溶解劑在新生兒動靜脈栓塞時使用的效果與安全性

搜尋策略

我們搜尋了Cochrane資料庫裏面2004年issue 2內有登錄的controlled trials, Mediline資料庫由1966年1月至2004年1月, EMBASE由1980年1月至2004年1月,和CINAHL由1982年1月至2004年1月所有的controlled trials.另外我們也與幾篇合適的review article的作者就文章連繫與討論.

選擇標準

所選的文章必須為randomised controlled trials. 其內容必須皆有針對有動靜脈栓塞引起症狀的新生兒接受血栓溶解劑 (thrombolytic agent) 和抗凝劑 (heparin) 或純觀察 (不用藥物介入) 的療效比較.

資料收集與分析

所搜尋到的文章中有兩篇獨立沒有相關的review.另外與這兩篇的作者 (reviewers) 聯繫後確定沒有任何與此主題相關而尚未發表的研究.

主要結論

沒有找到與此主題有相關的randomised controlled trials.

作者結論

由於沒有符合標準的文章,故沒有任何相關結論. 因此目前正是針對血栓溶解劑 (thrombolytis agent) 與抗凝劑 (heparin) 對新生兒栓塞治療效果比較進行研究的時機.

翻譯人

本摘要由高雄醫學大學附設醫院陳可欣翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

血栓在新生兒中並不經常發生,但在新生兒加護病房中卻可能造成非常嚴重的併發症.這些血栓多與置入新生兒體內的導管有關,尤其是像臍動靜脈導管這樣置入軀幹內部的導管,通常是臨床狀況較差的新生兒需要用此導管來監測或治療其疾病.有時候這些血栓並不會引起症狀,但若有症狀的話則可能會使循環變差,造成手,腳,腎臟,心臟,腦部,或是腸胃的傷害. 目前針對此狀況最常見的治療就是純觀察 (不作特別介入), 給予抗凝劑 (heparin) 或是血栓溶解劑 (streptokinase, urokinase, and TPA), 有時也會用外科的方式介入.要了解給與血栓溶解劑可能有造成嚴重出血的危險,所以了解以上各種療法可能造成的各樣長短期結果就顯得非常重要了.然而在我們所做得醫學文獻搜尋當中並沒有針對以上治療作比較的RCT.因此,目前並沒有針對這些治療在新生兒栓塞中作比較的結論.

Plain language summary

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.