Uso de rTPA e aspirina no tratamento de trombose intracardíaca em recém-nascido Combined rTPA and aspirin therapy for intracardiac thrombosis in neonates

Abstract

Descreve-se o caso de um recém-nascido prematuro de peso muito baixo, gemelar, com trombose intracardíaca. O recém-nascido apresentou quadro compatível com sepse neonatal, sendo submetido a suporte avançado de vida, terapia com antibióticos, nutrição parenteral, uso de hemoderivados e cateterismo venoso profundo. Evoluiu com suspeita de endocardite infecciosa, sendo realizada ecocardiografia bidimensional com Doppler, quando foi evidenciado volumoso trombo intracavitário. Pela alta letalidade e pela dificuldade técnica da cirurgia, que, em alguns casos, é contra-indicada, optou-se pelo uso do trombolítico ativador de plasminogênio tecidual recombinante humano (rTPA) associado a aspirina, obtendo-se dissolução total do trombo sem efeitos adversos.We describe a case of a very low birth weight premature female twin with intracardiac thrombosis. Her condition was consistent with neonatal sepsis, and she was treated with advanced life support, antibiotic therapy, parenteral nutrition, blood transfusion, and central venous catheterization. Infective endocarditis was suspected, and a large intracavitary thrombus was detected by two-dimensional Doppler echocardiography. Surgical procedure was not only technically difficult but also highly lethal, being contraindicated in some cases. Consequently, the use of the thrombolytic recombinant tissue-plasminogen activator (rTPA) associated with aspirin was the treatment of choice, and complete dissolution of the thrombus was achieved without adverse effects.

Keywords

• Fibrinolíticos
• plasminogênio
• aspirina
• trombose
• inibidores da agregação de plaquetas
• Fibrinolytic agents
• plasminogen
• aspirin
• thrombosis
• platelet aggregation inhibitors