(524) The Use of Tissue Plasminogen Activator in Children in the United States From 2000 – 2019

Introduction: Thrombolysis with tPA is uncommonly used in children, and its use is increasing. The study was aimed to describe the indications, complications, trends, and outcomes of tPA use in children in the United States.

Methods: A retrospective, serial cross-sectional analysis of Kids’ Inpatient Database from 2000 to 2019 was performed. Hospitalized children < 20 years were included. ICD 9 and 10 codes were used to identify tPA administration, indications, and complications. Chi-square, Mann-Whitney U, and Mantel Haenszel test for linear trend and binary regression analyses were performed for inferential statistics.

Results: Among a total of 48,458,466 hospitalized children from 2000-2019, 13,985 children (2.8 per 10,000 discharges) received tPA. Indications for the use of tPA included venous thrombosis (18.9%), catheter-related thrombosis (17.5%), pleural collections (15.4%), pulmonary embolism (8.5%), acute ischemic stroke (AIS; 4.4%), arterial thrombus (4.2%), renal vein thrombus (0.5%), right atrial thrombus (RAT; 0.5%), myocardial infarction (MI; 0.4%) and Kawasaki disease (0.2 %). The majority of the patients who received tPA were early adolescents (35.3%) with a median age of 13 years (IQR: 2-18). Bleeding complications were observed in 3.1% of tPA recipients. Binary regression analysis indicated that AIS (15.5%, OR=4.0, 95%CI: 2.3-6.8), MI (12.7%, OR=3.4, 95%CI: 1.2-9.6) and RAT (17.1%, OR=2.5, 95%CI: 1.05-6.29) were associated with a higher risk of bleeding compared to arterial thrombosis. The median length of stay (LOS) was 8 days (IQR: 4-17 days) and median charges were $90,120 (IQR: $40,404-$194,960). The median age was lower 6 years (IQR: 0-16), LOS was longer (20 day (IQR: 9-46)), and charges were higher $276,688 (IQR: $100,840 –$ 654,764) (p < 0.001) in those with complications. The mortality was 3.1% and was significantly higher in patients with complications (13.1%; OR=5.5, 95%CI: 4.0-7.2). Linear trend analysis demonstrated increased tPA use and complication rates (P < 0.001).

Conclusions: The use of tPA and related complications in the U.S are on an uptrend. Higher complication rates were observed with tPA use in AIS, MI, and RAT, which are associated with longer LOS, hospital charges, and mortality. The study reports national trends in tPA use and its complications.