- Dosages
- Side effects in children
- Warnings & precautions in children
- Contra-indications in children
-
Interactions - PK
- Renal impairment
- References
Pharmacokinetics in children
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dose recommendation of formulary compared to licensed use (on-label versus off-label)
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Available formulations
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Dosages
| Thrombolytic treatment of occluded central venous access devices (CVAD) |
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| Thrombolysis |
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Renal impaiment in children > 3 months
GFR ≥10 ml/min/1.73m2: Dose adjustment not required.
GFR <10 ml/min/1.73m2: A general recommendation on dose adjustment cannot be provided.
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The complete list of all undesirable drug reactions can be found in the national Summary of Product Characteristics (SmPC) – click here
Side effects
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The complete list of all contra-indications can be found in the national Summary of Product Characteristics (SmPC) – click here
Contra-indications in children
Watch out for an increased tendency to bleed: biopsies and surgery are contraindicated where urokinase is having a systemic effect.
The complete list of all warnings and precautions can be found in the national Summary of Product Characteristics (SmPC) – click here
Warnings & precautions in children
Strictly on indication: only use after consulting a haematologist.
Administration: preferably via catheter where the thrombus is located. Do not give heparin during thrombolysis
Checks prior to treatment: Lab checks: aPTT, PT, VBB, d-dimer, fibrinogen. In neonates: ultrasound of the cerebrum
Conditions for treatment with urokinase:
Thrombocytes > 50-100 x10e9/litre in sick patients
Thrombocytes > 50 x10e9/litre in stable patients
Fibrinogen > 1.0 mg/l
Normal or minimally extended PT and aPTT
If the thrombocyte count is low: thrombocyte transfusion
If the fibrinogen concentration is low: plasma transfusion
In cases of severe bleeding, tranexamic acid (Cyclokapron) can be given as an antidote. Risk factors include recent bleeding, surgery, peptic ulcer, ulcerative colitis.
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Interactions
The complete list of all interactions can be found in the national Summary of Product Characteristics (SmPC) – click here
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| Vitamin K antagonists | ||
|---|---|---|
| B01AA07 | ||
| B01AA04 | ||
| Heparin group | ||
|---|---|---|
| B01AB04 | ||
| B01AB09 | ||
| B01AB05 | ||
| B01AB01 | ||
| B01AB06 | ||
| B01AB10 | ||
| Platelet aggregation inhibitors excl. heparin | ||
|---|---|---|
| B01AC06 | ||
| B01AC04 | ||
| B01AC09 | ||
| Enzymes | ||
|---|---|---|
| B01AD02 | ||
| B01AD01 | ||
| Direct thrombin inhibitors | ||
|---|---|---|
| B01AE07 | ||
| Direct factor Xa inhibitors | ||
|---|---|---|
| B01AF02 | ||
| B01AF01 | ||
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References
- Rademaker C.M.A. et al, Geneesmiddelen-Formularium voor Kinderen, 2007
- CBO, Richtlijn Diagnostiek, preventie en behandeling van veneuze trombo-embolie en secundaire preventie van arteriele trombose, www.cbo.nl, 2009, 162
- Kamps WA et al, Werkboek ondersteundende behandeling kinderoncologie, VU Uitgeverij, 2005
- NVK, Werkboek kinderhematologie, www.hematologienederland.nl, 30 sept 2012
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Changes
Changes
