Successful thrombolysis by prolonged low‐dose alteplase in catheter‐directed infusion

Catheter‐directed thrombolysis is a sophisticated method in the treatment of thromboembolism with maximum effect on the thrombus and minimal systemic effect. The consequences are enhanced local thrombolysis and a reduction in general bleeding tendency, compared with systemic thrombolysis. At our institution, two children had successful thrombolysis by prolonged continuous catheter‐directed low‐dose alteplase. The first patient, a boy with Fontan physiology, was successfully treated for a massive pulmonary thromboembolism by catheter‐directed very low‐dose alteplase for five days. The second patient, who suffered from relapsing nephrotic syndrome, achieved satisfactory thrombolysis of an arterial leg thrombosis after four days of continuous catheter‐directed low‐dose alteplase. Conclusion: Although catheter‐directed thrombolysis seems to be a valuable method in thrombolytic therapy, there is a lack of evidence‐based recommendations concerning dosage, effect of bolus, simultaneous anticoagulation and duration of treatment for children.