Use of recombinant tissue plasminogen activator in children with meningococcal purpura fulminans: a retrospective study.

Détails

ID Serval
serval:BIB_8AA5D5254FC8
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Use of recombinant tissue plasminogen activator in children with meningococcal purpura fulminans: a retrospective study.
Périodique
Critical Care Medicine
Auteur(s)
Zenz W., Zoehrer B., Levin M., Fanconi S., Hatzis T.D., Knight G., Müllner M., Faust S.N. and 
ISSN
0090-3493
Statut éditorial
Publié
Date de publication
2004
Peer-reviewed
Oui
Volume
32
Numéro
8
Pages
1777-1780
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Résumé
OBJECTIVE: Meningococcal disease causes septic shock with associated disseminated intravascular coagulation and hemorrhagic skin necrosis. In severe cases, widespread vascular thrombosis leads to gangrene of limbs and digits and contributes to morbidity and mortality. Uncontrolled case reports have suggested that thrombolytic therapy may prevent some complications, and the use of tissue plasminogen activator (t-PA) has been widespread. Our aim was to summarize the clinical outcome and adverse effects where systemic t-PA has been used to treat children with fulminant meningococcemia. DESIGN: International, multiple-center, retrospective, observational case note study between January 1992 and June 2000. SETTING: Twenty-four different hospitals in seven European countries and Australia. PATIENTS: A total of 62 consecutive infants and children with severe meningococcal sepsis in whom t-PA was used for the treatment of predicted amputations and/or refractory shock (40 to treat severe ischemia, 12 to treat shock, and ten to treat both). INTERVENTIONS: t-PA was administered with a median dose of 0.3 mg.kg(-1).hr(-1) (range, 0.008-1.13) and a median duration of 9 hrs (range, 1.2-83). MAIN RESULTS: Twenty-nine of 62 patients died (47%; 95% confidence interval, 28-65). Seventeen of 33 survivors had amputations (11 below knee/elbow or greater loss; six less severe). In 12 of 50 patients to whom t-PA was given for imminent amputation, no amputations were observed. Five developed intracerebral hemorrhages (five of 62, 8%; 95% confidence interval, 0.5-16). Of these five, three died, one developed a persistent hemiparesis, and one recovered completely. CONCLUSIONS: The high incidence of intracerebral hemorrhage in our study raises concerns about the safety of t-PA in children with fulminant meningococcemia. However, due to the absence of a control group in such a severe subset of patients, whether t-PA is beneficial or harmful cannot be answered from the unrestricted use of the drug that is described in this report. Our experience highlights the need to avoid strategies that use experimental drugs in an uncontrolled fashion and to participate in multiple-center trials, which are inevitably required to study rare diseases.
Mots-clé
Amputation, Australia, Cerebral Hemorrhage, Child, Child, Preschool, Dose-Response Relationship, Drug, Drug Administration Schedule, Europe, Female, Humans, Infant, Infant, Newborn, Infusions, Intra-Arterial, Infusions, Intravenous, Male, Meningococcal Infections, Purpura, Schoenlein-Henoch, Retrospective Studies, Survival Analysis, Tissue Plasminogen Activator
Pubmed
Web of science
Création de la notice
25/01/2008 11:06
Dernière modification de la notice
03/03/2018 19:10
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