Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/S1677-54492007000100007
Jornal Vascular Brasileiro
Original Article

O uso da estreptoquinase no tratamento da oclusão arterial aguda pós-cateterização da artéria femoral em crianças com menos de 10 kg

The use of streptokinase in the treatment of acute arterial occlusion after catheterization of the femoral artery in children weighing less than 10 kg

Nilo César Barbosa Mandelli; Cláudio Nhuch; Paulo Roberto Fontes; Haroldo Diez Paiva; Raul Rossi; Mario Frederico Chagas Pereira; Silvio Perini

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Resumo

CONTEXTO: O tratamento da oclusão arterial aguda em menores de 5 kg tem constituído tema de discussão. OBJETIVOS: Avaliar o tratamento do quadro da oclusão arterial aguda pós-cateterismo da artéria femoral em crianças com menos de 10 kg com o uso de heparina isolada e também associada com estreptoquinase, e comparar os resultados do exame físico (como diagnóstico), da reversão da oclusão arterial, de complicações e de exames laboratoriais nos dois métodos MÉTODOS: Trinta casos de oclusão da artéria femoral foram identificados em 1.583 cateterismos em crianças no Instituto de Cardiologia de Porto Alegre, entre 1992 e 2000. Os pacientes foram divididos em dois grupos: um usou apenas heparina (14 casos), e o outro usou heparina associada com estreptoquinase (16 casos). Os exames laboratoriais (tempo de protrombina, tempo de tromboplastina parcial ativado e fibrinogênio) coletados antes e durante a infusão intravenosa foram avaliados estatisticamente, assim como o tempo de uso da medicação, as complicações e os resultados. RESULTADOS: O exame físico mostrou-se método fidedigno para avaliar a oclusão; no grupo que utilizou a associação de heparina e estreptoquinase, houve a resolução de 87% dos casos de oclusão arterial, e a principal complicação foi sangramento no sítio de punção em 56,3% dos pacientes. Os resultados apresentaram p < 0,05. Os exames laboratoriais não tiveram significado estatístico. CONCLUSÃO: A estreptoquinase associada com a heparina é mais efetiva do que a heparina isolada no tratamento da oclusão arterial aguda da artéria femoral pós-cateterismo, tanto que sua associação apresenta uma redução do risco relativo de 88% em relação à heparina isolada.

Palavras-chave

Estreptoquinase, criança, cateterismo, oclusão arterial

Abstract

BACKGROUND: The treatment of acute arterial occlusion in children weighing less than 5 kg has been widely discussed. OBJECTIVES: To evaluate the treatment of acute arterial occlusion after catheterization of the femoral artery in children weighing less than 10 kg using heparin alone and associated with streptokinase, and to compare the results of physical examination (such as diagnosis), reversal of the arterial occlusion, complications and laboratory tests between both methods. METHODS: Thirty cases of femoral artery occlusion were identified among 1,583 catheterizations in children at Instituto de Cardiologia de Porto Alegre between 1992 and 2000. The patients were divided into two groups: one used heparin alone (14 cases) and the other used heparin associated with streptokinase (16 cases). The laboratory tests (prothrombin time, activated partial thromboplastin time and fibrinogen) performed before and during the intravenous infusion were statistically analyzed, as well as period of drug administration, complications and results. RESULTS: Physical examination proved to be reliable to evaluate occlusion; in the group using heparin associated with streptokinase, there was resolution of the arterial occlusion in 87% of cases, and the main complication was bleeding at the puncture site, which was present in 56.3% of the patients. These results showed p < 0.05. Laboratory tests were not statistically significant. CONCLUSION: Streptokinase associated with heparin is more effective on acute artery occlusions following femoral catheterization than heparin alone. Its association presents an 88% rate of relative risk reduction in relation to heparin alone.

Keywords

Streptokinase, child, catheterization, arterial occlusion

References

Haimovici H. Arterial embolism of the extremities and technique of embolectomy. Vascular surgery: principles and techniques. 1996:423-44.

Hurwitz RA, Franken EA Jr., Girod DA, Smith JA, Smith WL. Angiographic determination of arterial patency after percutaneous catheterization in infants and small children. Circulation. 1977;56:102-5.

Fairbairn JF. Clinical manifestations of perpheral vascular disease. II. Peripheral vascular disease. 1980:3.

Burrows PE, Benson LN, Williams WG. Iliofemoral arterial complications of balloon angioplasty for systemic obstructions in infants and children. Circulation. 1990;82:1697-704.

Wessel DL, Keane JF, Fellows KE, Robichaud H, Lock JE. Fibrinolytic therapy for femoral arterial thrombosis after cardiac catheterization in infants and children. Am J Cardiol. 1986;58:347-51.

Fogarty TJ, Rutherford RB. Vascular surgery. 1995:410-4.

Ino T, Benson LN, Freedom RM, Barker GA, Airpursky A, Rowe RD. Thrombolytic therapy for femoral artery thrombosis after pediatric cardiac catheterization. Am Heart J. 1988;115:633-9.

Stanger P, Heymann MA, Tarnoff H, Hoffman JI, Rudolph AM. Complications of cardiac catheterization of neonates, infants, and children: A three-year study. Circulation. 1974;50:595-608.

Mansfield PB, Gazzaniga AB, Litwin SB. Management of arterial injuries related to cardiac catheterization in children and young adults. Circulation. 1970;42:501-7.

Mason AC, Llull R, Bentz ML. Revascularization of the upper extremity in a preterm infant: a case report and review of the literature. Ann Plast Surg. 1999;43:646-8.

While JS, Talbert JL, Haller JA Jr. Peripheral arterial injuries in infants and children. Ann Surg. 1968;167:757-67.

Beaty JH. Congenital anomalies of lower extremity. Campbell 's operative orthopedics. 1987:2623-780.

Corrigan JJ Jr., Sleeth JJ, Jeter M, Lox CD. Newborn's fibrinolytic mechanism: components and plasmin generation. Am J Hematol. 1989;32:273-8.

Seldinger SI. Catheter replacement of the needle in percutaneous arteriography: a new technique. Acta Radiol. 1953;39:368-76.

Tokel K, Yildirim SV, Varan B, Ekici E. Sequential balloon dilatation for combined aortic valvular stenosis and coarctation of the aorta in a single catheterization procedure: a prognostic evaluation based on long-term follow up. J Invasive Cardiol. 2006;18:65-9.

Galal MO, Schmaltz AA, Joufan M, Benson L, Samatou L, Halees Z. Balloon dilation of native aortic coarctation in infancy. Z Kardiol. 2003;92:735-41.

Saxena A, Gupta R, Kumar RK, Kothari SS, Wasir HS. Predictors of arterial thrombosis after diagnostic cardiac catheterization in infants and children randomized to two heparin dosages. Cathet Cardiovasc Diagn. 1997;41:400-3.

Brus F, Witsenburg M, Hofhuis WJ, Hazelzet JA, Hess J. Streptokinase treatment for femoral artery thrombosis after arterial cardiac catheterisation in infants and children. Br Heart J. 1990;63:291-4.

Gamba P, Pettenazzo A, Kalapurackal M, Saia SO, Guglielmi M. Primary occlusion of the iliac and femoral artery in two newborn infants: efficacy of medical treatment. J Pediatr Surg. 1993;28:735-7.

Kothari SS, Kumar RK, Varma S, Saxena A. Thrombolytic therapy in infants for femoral artery thrombosis following cardiac catheterization. Indian Heart J. 1996;48:246-8.

Saxena A, Gupta R, Kumar RK, Kothari SS, Wasir HS. Predictors of arterial thrombosis after diagnostic cardiac catheterization in infants and children randomized in two heparin dosages. Cathet Cardiovasc Diagn. 1997;41:400-3.

Richardson R, Applebaum H, Touran T. Effective thrombolytic therapy of aortic thrombosis in the small premature infant. J Pediatr Surg. 1988;23:1198-200.

Strife JL, Ball WS Jr., Towbin R, Keller MS, Dillon T. Arterial occlusions in neonates: use of fibrinolytic therapy. Radiology. 1988;166:395-400.

Aydogan U. Arterial duct closure with detachable coils: application in the small child. Asian Cardiovasc Thorac Ann. 2002;10:124-8.

Agnoletti G, Bonnet C, Boudjemline Y. Complications of pediatric interventional catheterisation: an analysis of risk factors. Cardiol Young. 2005;15:402-8.

Ross P Jr., Ehrenkranz R, Kleinman CS, Seashore JH. Thrombus associated with central venous catheters in infants and children. J Pediatr Surg. 1989;24:253-6.

O'Relly RA. Anticoagulants, antithrombotics and thrombolytics drugs. The pharmacological basis of therapeutics. 1987:878-90.

Verstraete M, Vermylen J, Amery A, Vermylen C. Thrombolytic therapy with streptokinase using a standard dosage scheme. Br Med J. 1966;1:454-6.

Deucher GP, Mickelberg A, Nunes P, Cabral CA, Degni M. Nossa experiência clínica com a fibrinoliticoterapia pela estreptocinase nas embolias e tromboses arteriais. Rev Bras Cardiovasc. 1975;11:112-7.

Albisetti M, Schmugge M, Haas R. Arterial thromboembolic complications in critically ill children. J Crit Care. 2005;20:296-300.

The Thrombolysis in Myocardial Infarction (TIMI) trial: Phase I findings. TIMI Study Group. N Engl J Med. 1985;312:932-6.

Van de Werf F, Ludbrook PA, Bergmann SR. Coronary thrombolysis with tissue-type plasminogen activator in patients with evolving myocardial infarction. N Engl J Med. 1984;310:609-13.

Fletcher RH, Fletcher SW, Wagner EH. Tratamento. Epidemiologia clínica: elementos essenciais. 1996:145-73.

Haimovici H. Acute arterial thrombosis. Vascular surgery: principles and techniques. 1996:458-65.

Ramos AI, Ramos RF, Togna DJ. Fibrinolytic therapy for thrombosis in cardiac valvular prosthesis short and long term results. Arq Bras Cardiol. 2003;81:393-8.

Gupta D, Kothari SS, Bahl VK. Thrombolytic therapy for prosthetic valve thrombosis: short-and long-term results. Am Heart J. 2000;140:906-16.

Bolz D, Kuhne T, Jivraj R, Hammer J. Thrombolysis of prosthetic tricuspid valve thrombosis with human recombinant tissue plasminogen activator in an adolescent. Pediatr Cardiol. 2000;21:397-400.

Atiyeh BS, Hashim HA, Hamdan AM, Musharafieh RS. Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery. Microsurgery. 1999;19:265-71.

Bergstrom K, Jorulf H. Reaction of femoral and common carotid arteries in infants after puncture or percutaneous catheterization. Acta Radiol Diagn. 1976;17:577-80.

Pousti TJ, Wilson SE, Willams RA. Clinical examination of the vascular system. Vascular surgery: principles and practice. 1994:74-89.

Ascer E, Gennaro M, Chittur Mohan, Veith FJ. Management of acute lower-extremety ischemia. Vascular surgery: theory and practice. 1995:715-34.

Kirk CR, Qureshi SA. Streptokinase in management of arterial thrombosis in infancy. Int J Cardiol. 1989;25:15-20.

Kothari SS, Varma S, Wasir HS. Thrombolytic therapy in infants and children. Am Heart J. 1994;127:651-7.

Corrigan JJ Jr., Sleeth JJ, Jeter M, Lox CD. Newborn's fibrinolytic mechanism: components and plasmin generation. Am J Hematol. 1989;32:273-8.

Peters M, ten Cate JW, Jansen E, Breederveld C. Coagulation and fibrinolytic factors in the first week of life in healthy infants. J Pediatr. 1985;106:292-5.

Peters M, ten Cate JW, Koo LH, Breederveld C. Persistent antithrombin III deficiency: risk factor for thromboembolic complications in neonates small for gestacional age. J Pediatr. 1984;105:310-4.

Vergnes C, Larnaudie B, Hourdille P, Roudaut MF, Choussat A, Boisseau MR. Thrombose aortique abdominale sous-renale neonatale. Presse Med. 1985;14:492-9.

Batsford S, Brundiers M, Schweier O, Horbach E, Monting JS. Antibody to streptococcal cysteine proteinase as a seromarker of group A Streptococcal (Streptococcus pyogenes) infections. Scand J Infect Dis. 2002;34:407-12.

Nowak-Gottl U, Auberger K, Halimeh S. Thrombolysis in newborns and infants. Thromb Haemost. 1999;82(^s1):112-6.

Vojdani A, Bazargan M, Vojdani E. Heat shock protein and gliadin peptide promote development of peptidase antibodies in children with autism and patients with autoimmune disease. Clin Diagn Lab Immunol. 2004;11:515-24.

Pritchard SL, Culham JA, Rogers PC. Low-dose fibrinolytic therapy in infants. J Pediatr. 1985;106:594-8.

Silver D, Kikta MJ. Thrombogenesis and thrombolysis. Vascular surgery: principles and techniques. 1996:195-208.

Keller PK, Silver D. Anticoagulants: heparin and warfarin. Vascular surgery: principles and practice. 1994:219-27.

Bovill EG, Becker R, Tracy RP. Monitoring thrombolytic therapy. Prog Cardiovasc Dis. 1992;34:279-94.

Estelles A, Aznar J, Gilabert J, Parrilla JJ. Dysfunctional plasminogen in full-term newborn. Pediatr Res. 1980;14:1180-5.

Marder VJ, Sherry S. Thrombolytic therapy: current status (1). N Engl J Med. 1988;318:1512-20.

Marder VJ, Sherry S. Thrombolytic therapy: current status (2). N Engl J Med. 1988;318:1585-95.

Reznik VM, Anderson J, Griswold WR, Segall ML, Murphy JL, Mendoza SA. Successful fibrinolytic treatment of arterial thrombosis and hypertension in a cocaine-exposed neonate. Pediatrics. 1989;84:735-8.

Zenz W, Arlt F, Sodia S, Berghold A. Intracerebral hemorrhage during fibrinolytic therapy in children: a review of the literature of the last thirty years. Semin Thromb Hemost. 1997;23:321-32.

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