Characteristics of the included studies for all locations
| Author (year) . | Study design . | Age group . | Population . | Thrombolytic therapy followed by AC . | AC . | Outcomes . | Additional information on thrombolysis . | Follow-up time . |
|---|---|---|---|---|---|---|---|---|
| Ross et al20 (2020) | Retrospective cohort | 0-18 years | Submassive PE | Systemic thrombolysis or CDT (n = 14) | AC (n = 9) | Mortality, bleeding, and progression | Systemic thrombolysis or CDT | N/A |
| Ross et al20 (2020) | Retrospective cohort | 0-18 years | PE with hemodynamic compromise | Systemic thrombolysis or CDT (n = 7) | AC (n = 1) | Mortality, bleeding | Systemic thrombolysis or CDT | N/A |
| Belsky et al21 (2020) | Case series | 0-18 years | Submassive PE | CDT (n = 5) | AC (n = 3) | Thrombus resolution (complete or partial), PTS, MB, and CRNMB | Up-front thrombolytic therapy consists of suction thrombectomy or mechanical clot disruption. After clot reduction, catheter-directed lysis. Alteplase dose used for CDT was 0.03 mg/kg per hour (maximum dose 2 mg/h). | 6 months |
| Pelland-Marcotte et al19 (2019) | Retrospective cohort | 0-18 years | PE with hemodynamic compromise | Systemic thrombolysis or CDT (n = 7) | AC (n = 15) | All-cause mortality, thrombus recurrence | Systemic thrombolysis or CDT | Median, 2.4 years |
| Warad et al25 (2020) | Retrospective cohort | 0-18 years | May-Thurner | Systemic thrombolysis or CDT (n = 6) | AC (n = 3) | Mortality, thrombus resolution (complete or partial) thrombus recurrence, and PTS | Systemic and CDT (catheter-directed, 5; systemic, 1) Catheter-directed alteplase (0.5 and 1 mg/h) Systemic t-PA (0.03 and 0.06 mg/kg per hour) | Median, 1.2 years |
| van Ommen et al22 (2023) | Prospective observational | <6 months | DVT (CVAD) | Systemic thrombolysis (n = 1) | AC (n = 36) | Mortality, thrombus resolution (complete or partial) MB, CRNMB, and thrombus recurrence | Systemic r-tPA The starting and maximum dosages of r-tPA varied between 0.1 and 0.3 mg/kg per hour and between 0.3 and 0.5 mg/kg per hour, respectively. The duration of thrombolysis varied between 6 and 24 hours. | Mean, 40 days |
| Tarango et al24 (2018) | Retrospective cohort | 0-18 years | Lower extremity DVT with IVC atresia | CDT (n = 12) | AC (n = 6) | Mortality, thrombus recurrence, and PTS | Percutaneous endovascular thrombolysis in addition to AC therapy, n = 12 | Range, 6-53 months |
| Kumar et al23 (2019) | Retrospective cohort | 0-18 years | Paget-Schroetter syndrome | Systemic thrombolysis or CDT (n = 10) | AC (n = 12) | Mortality, PTS, MB, CRNMB thrombus resolution (complete or partial), and thrombus recurrence | 10 patients underwent up-front thrombolytic therapy (9 patients had CDT and 3 patients had pharmacomechanical thrombolysis [AngioJet]). CDT was performed through an infusion catheter placed in the interventional radiology suite. r-tPA (dose 0.03 mg/kg per hour [maximum dose 2 mg/h]) was infused directly into the thrombus. Median (IQR) duration of CDT in all patients was 48 hours (24-72). | Median, ∼4 years |
| Goldenberg et al26 (2007) | Retrospective cohort | 6 months to 21 years | Lower extremity DVT, different risk factors | Systemic or CDT, thrombolysis (n = 9) | AC (n = 13) | Thrombus resolution (complete or partial), PTS, and MB | Systemic and CDT (n = 7 systemic, n = 2 CDT) tPA, infusion was begun at 0.03 mg/kg per hour. Maximum duration of systemic tPA infusion was 96 hours. | 24 months |
| van Ommen et al22 (2023) | Prospective observational | <6 months | RAT CVAD | Systemic thrombolysis (n = 6) | AC (n = 14) | MB, CRNMB, extension, thrombus resolution (complete or partial), and recurrence of thrombus | Six infants were treated with r-tPA. The starting and maximum dosages of r-tPA varied between 0.1 and 0.3 .5 mg/kg per hour and between 0.3 and 0.5 mg/kg per hour, respectively. The duration of thrombolysis varied between 6 and 24 hours. | Mean, 56 days |
| Odaman Al et al27 (2022) | Case series | 0-18 years | RAT | Systemic thrombolysis (n = 4) | AC (n = 9) | Mortality, thrombus resolution (complete or partial), and bleeding | Systemic r-tPA: 0.2-0.5 mg/kg per hour (6-hour infusion); 0.01-0.06 mg/kg per hour (24-hour infusion) | 6.5 months |
| Kara et al28 (2021) | Retrospective observational | 0-18 years | RAT | Systemic thrombolysis (n = 7) | AC (n = 4) | Mortality, thrombus resolution (complete or partial) | Systemic thrombolysis. In 3 patients, r-tPA was started with low dose (0.01 mg/kg per hour) and increased gradually to 0.06 mg/kg per hour. In 3 patients, r-tPA was started with standard dose (0.5 mg/kg per hour). In 1 patient, r-tPA was started with low dose (0.01 mg/kg per hour) and increased to standard dose. | N/A |
| Rong et al29 (2020) | Case series | 3-10 years | CSVT (nephrotic syndrome) | Systemic thrombolysis (n = 6) | AC (n = 4) | Mortality, thrombus resolution (complete or partial), and thrombus recurrence | Urokinase was used as a thrombolytic therapy as well as xueshuantong, which is a Chinese patent medicine containing extractive ingredients of herb for AC (n = 6/10). | N/A |
| Likoho et al31 (2023) | Retrospective observational | Neonates (<28 days) | Bilateral RVT | Systemic thrombolysis (n = 4) | AC (n = 3) | Mortality, bleeding, thrombus resolution (complete or partial), thrombus recurrence, proteinuria, CKD, HBP, and long-term kidney feature | Received fibrinolysis with tPA | Median, 5.7 years |
| Niada et al30 (2018) | Case series | Neonates (<28 days) | Unilateral RVT | Systemic thrombolysis (n = 3) | N/A | Thrombus resolution (complete or partial), progression, atrophic kidney function, normal HBP, and CKD | Patients 3, 4, and 5 received antithrombotic treatment with r-tPA. Thrombolysis was attempted as follows: r-tPA 0.1 mg/kg as bolus, followed by 0.3 mg/kg over 3 hours (patients 4 and 5) and 0.9 mg/kg over 3 hours in patient 3. If repermeabilization was deemed unsatisfactory, repeat doses were administered, with 0.3 mg/kg over 3 hours after a time interval of 12-24 hours after the previous perfusion. | 6 months |
| Author (year) . | Study design . | Age group . | Population . | Thrombolytic therapy followed by AC . | AC . | Outcomes . | Additional information on thrombolysis . | Follow-up time . |
|---|---|---|---|---|---|---|---|---|
| Ross et al20 (2020) | Retrospective cohort | 0-18 years | Submassive PE | Systemic thrombolysis or CDT (n = 14) | AC (n = 9) | Mortality, bleeding, and progression | Systemic thrombolysis or CDT | N/A |
| Ross et al20 (2020) | Retrospective cohort | 0-18 years | PE with hemodynamic compromise | Systemic thrombolysis or CDT (n = 7) | AC (n = 1) | Mortality, bleeding | Systemic thrombolysis or CDT | N/A |
| Belsky et al21 (2020) | Case series | 0-18 years | Submassive PE | CDT (n = 5) | AC (n = 3) | Thrombus resolution (complete or partial), PTS, MB, and CRNMB | Up-front thrombolytic therapy consists of suction thrombectomy or mechanical clot disruption. After clot reduction, catheter-directed lysis. Alteplase dose used for CDT was 0.03 mg/kg per hour (maximum dose 2 mg/h). | 6 months |
| Pelland-Marcotte et al19 (2019) | Retrospective cohort | 0-18 years | PE with hemodynamic compromise | Systemic thrombolysis or CDT (n = 7) | AC (n = 15) | All-cause mortality, thrombus recurrence | Systemic thrombolysis or CDT | Median, 2.4 years |
| Warad et al25 (2020) | Retrospective cohort | 0-18 years | May-Thurner | Systemic thrombolysis or CDT (n = 6) | AC (n = 3) | Mortality, thrombus resolution (complete or partial) thrombus recurrence, and PTS | Systemic and CDT (catheter-directed, 5; systemic, 1) Catheter-directed alteplase (0.5 and 1 mg/h) Systemic t-PA (0.03 and 0.06 mg/kg per hour) | Median, 1.2 years |
| van Ommen et al22 (2023) | Prospective observational | <6 months | DVT (CVAD) | Systemic thrombolysis (n = 1) | AC (n = 36) | Mortality, thrombus resolution (complete or partial) MB, CRNMB, and thrombus recurrence | Systemic r-tPA The starting and maximum dosages of r-tPA varied between 0.1 and 0.3 mg/kg per hour and between 0.3 and 0.5 mg/kg per hour, respectively. The duration of thrombolysis varied between 6 and 24 hours. | Mean, 40 days |
| Tarango et al24 (2018) | Retrospective cohort | 0-18 years | Lower extremity DVT with IVC atresia | CDT (n = 12) | AC (n = 6) | Mortality, thrombus recurrence, and PTS | Percutaneous endovascular thrombolysis in addition to AC therapy, n = 12 | Range, 6-53 months |
| Kumar et al23 (2019) | Retrospective cohort | 0-18 years | Paget-Schroetter syndrome | Systemic thrombolysis or CDT (n = 10) | AC (n = 12) | Mortality, PTS, MB, CRNMB thrombus resolution (complete or partial), and thrombus recurrence | 10 patients underwent up-front thrombolytic therapy (9 patients had CDT and 3 patients had pharmacomechanical thrombolysis [AngioJet]). CDT was performed through an infusion catheter placed in the interventional radiology suite. r-tPA (dose 0.03 mg/kg per hour [maximum dose 2 mg/h]) was infused directly into the thrombus. Median (IQR) duration of CDT in all patients was 48 hours (24-72). | Median, ∼4 years |
| Goldenberg et al26 (2007) | Retrospective cohort | 6 months to 21 years | Lower extremity DVT, different risk factors | Systemic or CDT, thrombolysis (n = 9) | AC (n = 13) | Thrombus resolution (complete or partial), PTS, and MB | Systemic and CDT (n = 7 systemic, n = 2 CDT) tPA, infusion was begun at 0.03 mg/kg per hour. Maximum duration of systemic tPA infusion was 96 hours. | 24 months |
| van Ommen et al22 (2023) | Prospective observational | <6 months | RAT CVAD | Systemic thrombolysis (n = 6) | AC (n = 14) | MB, CRNMB, extension, thrombus resolution (complete or partial), and recurrence of thrombus | Six infants were treated with r-tPA. The starting and maximum dosages of r-tPA varied between 0.1 and 0.3 .5 mg/kg per hour and between 0.3 and 0.5 mg/kg per hour, respectively. The duration of thrombolysis varied between 6 and 24 hours. | Mean, 56 days |
| Odaman Al et al27 (2022) | Case series | 0-18 years | RAT | Systemic thrombolysis (n = 4) | AC (n = 9) | Mortality, thrombus resolution (complete or partial), and bleeding | Systemic r-tPA: 0.2-0.5 mg/kg per hour (6-hour infusion); 0.01-0.06 mg/kg per hour (24-hour infusion) | 6.5 months |
| Kara et al28 (2021) | Retrospective observational | 0-18 years | RAT | Systemic thrombolysis (n = 7) | AC (n = 4) | Mortality, thrombus resolution (complete or partial) | Systemic thrombolysis. In 3 patients, r-tPA was started with low dose (0.01 mg/kg per hour) and increased gradually to 0.06 mg/kg per hour. In 3 patients, r-tPA was started with standard dose (0.5 mg/kg per hour). In 1 patient, r-tPA was started with low dose (0.01 mg/kg per hour) and increased to standard dose. | N/A |
| Rong et al29 (2020) | Case series | 3-10 years | CSVT (nephrotic syndrome) | Systemic thrombolysis (n = 6) | AC (n = 4) | Mortality, thrombus resolution (complete or partial), and thrombus recurrence | Urokinase was used as a thrombolytic therapy as well as xueshuantong, which is a Chinese patent medicine containing extractive ingredients of herb for AC (n = 6/10). | N/A |
| Likoho et al31 (2023) | Retrospective observational | Neonates (<28 days) | Bilateral RVT | Systemic thrombolysis (n = 4) | AC (n = 3) | Mortality, bleeding, thrombus resolution (complete or partial), thrombus recurrence, proteinuria, CKD, HBP, and long-term kidney feature | Received fibrinolysis with tPA | Median, 5.7 years |
| Niada et al30 (2018) | Case series | Neonates (<28 days) | Unilateral RVT | Systemic thrombolysis (n = 3) | N/A | Thrombus resolution (complete or partial), progression, atrophic kidney function, normal HBP, and CKD | Patients 3, 4, and 5 received antithrombotic treatment with r-tPA. Thrombolysis was attempted as follows: r-tPA 0.1 mg/kg as bolus, followed by 0.3 mg/kg over 3 hours (patients 4 and 5) and 0.9 mg/kg over 3 hours in patient 3. If repermeabilization was deemed unsatisfactory, repeat doses were administered, with 0.3 mg/kg over 3 hours after a time interval of 12-24 hours after the previous perfusion. | 6 months |
CKD, chronic kidney disease; CVAD, central venous access device; HBP, high blood pressure; IQR, interquartile range; N/A, not available; r-tPA, recombinant tissue plasminogen activator; tPA, tissue plasminogen activator.