Streptokinase treatment for femoral artery thrombosis after cardiac catheterization in children

Background: Cardiac catheterization like other invasive procedures is afflicted with complications, one of the most important complications is vessel obstruction and arterial thrombosis that need urgent medical treatment. By means of operation or use of thrombolytic agents morbidity has been decreased. Because of scarcity of studies on the use of thrombolytic agents for vessel obstruction, especially in Iran, we studied the effectiveness of thrombolytic agents in vessel obstruction due to cardiac catheterization in children.
Methods: This semi experimental study was performed from March 2001 to November 2004. We investigated 33 patients with vascular obstruction from 400 patients who underwent cardiac catheterization. Patients' age ranged from 2.5 to 72 months. Vessel obstruction was detected by physical examination of the distal extremities (pale, pulseless, cold foot) and pulse oximetry. Children with signs and symptoms of vessel obstruction without response to supportive care after 4 hours received streptokinase (Biotec Heber), they received 2000 u/kg as loading dose during 20-30 minutes and 1000 u/kg/h as continuous infusion. Streptokinase infusion decreased during 2-3 hours and discontinued after detection of pulse in foot (by means of pulse oximetry and physical examination). Some patients received corticosteroid and H2 blocker (ranitidine or cimetidine). Data are analyzed by SPSS software.
Findings: In this study mean age of the patients was 19.1±18.89 months, mean weight 7.9±4.1 kg and mean infusion time of streptokinase 17±12.4 hours. There was significant relation between weight and infusion time (p=0.049), and also there was significant relation between age and infusion time (p=0.039). There was significant relation between infusion time and type of cardiac defect (p=0.049). There was no significant relation between infusion time and sex of the patient (p>0.05). Results showed that the most common side effects were local blood oozing (27.5%) and hematoma (24.5%).
Conclusion: Results showed that streptokinase can be effective in removing of vessel obstruction almost always after cardiac catheterization; it can also be a suitable replacement for Fougarty catheter to remove blood clots in cardiac catheterization especially in infants.