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Reports in the literature of treatment with recombinant tissue plasminogen activator following cardiac surgery are limited. We reviewed our experience to provide a case series of the therapeutic use of tissue plasminogen activator for the treatment of venous thrombosis in children after cardiac surgery. The data describe the morbidity, mortality, and clinical outcomes of tissue plasminogen activator administration for treatment of venous thrombosis in children following cardiac surgery.
The study was designed as a retrospective case series.
The study was carried out in a 25-bed cardiac intensive care unit in an academic, free-standing paediatric hospital.
All children who received tissue plasminogen activator for venous thrombosis within 60 days of cardiac surgery, a total of 13 patients, were included.
Data was collected, collated, and analysed as a part of the interventions of this study.
Measurements and main results
Patients treated with tissue plasminogen activator were principally young infants (median 0.2, IQR 0.07–0.58 years) who had recently (22, IQR 12.5–27.3 days) undergone cardiac surgery. Hospital mortality was high in this patient group (38%), but there was no mortality attributable to tissue plasminogen activator administration, occurring within <72 hours. There was one major haemorrhagic complication that may be attributable to tissue plasminogen activator. Complete or partial resolution of venous thrombosis was confirmed using imaging in 10 of 13 patients (77%), and tissue plasminogen activator administration was associated with resolution of chylous drainage, with no drainage through chest tubes, at 10 days after tissue plasminogen activator treatment in seven of nine patients who had upper-compartment venous thrombosis-associated chylothorax.
On the basis of our experience with administration of tissue plasminogen activator in children after cardiac surgery, tissue plasminogen activator is both safe and effective for resolution of venous thrombosis in this high-risk population.
There are several ways planets can survive the giant phase of the host star, hence one can consider the case of Earth-like planets orbiting white dwarfs. As a white dwarf cools from 6000 K to 4000 K, a planet orbiting at 0.01 AU from the star would remain in the continuous habitable zone (CHZ) for about 8 Gyr. Polarisation due to a terrestrial planet in the CHZ of a cool white dwarf (CWD) is 102 (104) times larger than it would be in the habitable zone of a typical M-dwarf (Sun-like star). Polarimetry is thus a powerful tool to detect close-in planets around white dwarfs. Multi-band polarimetry would also allow one to reveal the presence of a planet atmosphere, even providing a first characterisation. With current facilities a super-Earth-sized atmosphereless planet is detectable with polarimetry around the brightest known CWD. Planned future facilities render smaller planets detectable, in particular by increasing the instrumental sensitivity in the blue. Preliminary habitability study show also that photosynthetic processes can be sustained on Earth-like planets orbiting CWDs and that the DNA-weighted UV radiation dose for an Earth-like planet in the CHZ is less than the maxima encountered on Earth, hence white dwarfs are compatible with the persistence of complex life from the perspective of UV irradiation.
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