The use of recombinant tissue-type plasminogen activator in a newborn with an intracardiac thrombus developed during extracorporeal membrane oxygenation Academic Article uri icon


MeSH Major

  • Extracorporeal Membrane Oxygenation
  • Fibrinolytic Agents
  • Foramen Ovale, Patent
  • Heart Diseases
  • Intracranial Hemorrhages
  • Respiratory Distress Syndrome, Newborn
  • Thrombolytic Therapy
  • Thrombosis
  • Tissue Plasminogen Activator


  • Extracorporeal membrane oxygenation (ECMO) support is often used to support infants and children with hemodynamic or respiratory failure. One of the major obstacles of safely treating a child with ECMO is balancing the risk of hemorrhage with the potential for thrombus development. Managing thrombosis in the setting of ECMO is challenging and has no defined algorithm. The use of recombinant tissue-type plasminogen activator (tPA) for thrombolysis has been previously described in cases where thrombi have developed despite adequate anticoagulation. In such situations, the risk of hemorrhage must be carefully balanced with the benefit of dissolving the clot and reestablishing flow. We present a case of an infant who required ECMO because of severe primary pulmonary hypertension and subsequently developed a right atrial thrombus adjacent to the ECMO cannula. The patient was treated with tPA with immediate improvement but had fatal intracranial hemorrhage almost 3 days after the tPA was administered. In this report, we review the current literature on tPA use during ECMO support and suggest a rational approach.

publication date

  • October 2011



  • Academic Article



  • eng

Digital Object Identifier (DOI)

  • 10.1016/j.jpedsurg.2011.06.039

PubMed ID

  • 22008344

Additional Document Info

start page

  • 2021

end page

  • 4


  • 46


  • 10