Permissions and Reprints(opens in new window) Abstract Introduction

The literature is limited regarding the use of recombinant tissue plasminogen activator (r-tPA) in premature infants. We describe the use of r-tPA to treat life-threatening intra- and extracardiac thrombi in a very low birth weight patient born at 23 weeks of gestational age.

Case Report

An extremely premature infant was diagnosed with multiple thrombi at 4 weeks of age. The acute phase of treatment was managed with an infusion of r-tPA followed by unfractionated heparin, then low-molecular-weight heparin for continued anticoagulation. The patient did not experience any side effects associated with the therapies and was discharged home.

Conclusion

Thrombotic events in neonates, though rare, are being increasingly identified due to improved survival of premature infants, enhanced diagnostic modalities, and the widespread use of central venous catheters. Heparin remains the standard of care in neonates for anticoagulation. Thrombolytic therapy with agents such as r-tPA, though less frequently employed, may be lifesaving in certain instances, such as the one presented in this case report.

Key Points

r-tPA use in premature infants may resolve thrombi.

r-tPA can be used safely in extremely low birth weight infants.

Heparin/r-tPA is used to treat multiple cardiac thrombi.

Keywords infant - extremely premature - thrombosis - thrombolytic therapy - heparin - recombinant tissue plasminogen activator - heparin - low-molecular-weight Contributors' Statement

K.M.: Conceptualization, investigation, methodology, project administration, supervision, validation, visualization, writing–original draft, writing–review and editing. C.W.: Conceptualization, investigation, methodology, project administration, supervision, validation, visualization, writing–original draft, writing–review and editing. B.M.: Conceptualization, investigation, methodology, project administration, supervision, validation, visualization, writing–original draft, writing–review and editing. M.V.: Conceptualization, investigation, methodology, project administration, validation, visualization, writing–original draft, writing–review and editing. N.W.: Conceptualization, investigation, methodology, project administration, validation, writing–original draft, writing–review and editing.

Publication History

Received: 07 October 2025

Accepted: 23 November 2025

Article published online:
14 January 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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