Successful Use of Recombinant Tissue Plasminogen Activator in an Extremely Low Birth Weight Premature Infant for the Resolution of Multiple Thrombi

Introduction: The literature is limited regarding the use of recombinant tissue plasminogen activator (r-tPA) in premature infants. We describe the use of r-tPA to treat life-threatening intra- and extracardiac thrombi in a very low birth weight patient born at 23 weeks of gestational age. Case Report: An extremely premature infant was diagnosed with multiple thrombi at 4 weeks of age. The acute phase of treatment was managed with an infusion of r-tPA followed by unfractionated heparin, then low-molecular-weight heparin for continued anticoagulation. The patient did not experience any side effects associated with the therapies and was discharged home. Conclusion: Thrombotic events in neonates, though rare, are being increasingly identified due to improved survival of premature infants, enhanced diagnostic modalities, and the widespread use of central venous catheters. Heparin remains the standard of care in neonates for anticoagulation. Thrombolytic therapy with agents such as r-tPA, though less frequently employed, may be lifesaving in certain instances, such as the one presented in this case report.