Right atrial thrombosis in two premature infants: successful treatment with urokinase and heparin.

Vascular thrombosis is a harmful and rather frequent event in sick premature infants. Only recently has intracardiac thrombosis been described in preterm babies and virtually all the surviving cases are those treated surgically. We report the cases of two premature infants with intra-atrial thrombosis detected by cross-sectional echocardiography and successfully treated with heparin and urokinase for 12 and 16 days, respectively. Our patients required larger doses of urokinase over a longer period of time than are required at older ages to obtain thrombolysis. Our data suggest that fibrinolytic therapy may be an alternative to surgery in premature babies with right atrial thrombosis and that cross-sectional echocardiography is very useful in the titration of the therapy in order to achieve consistent dissolution of the thrombus.