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Anticoagulants in pediatric cerebral sinovenous thrombosis: a safety and outcome study

Mahendranath D Moharir1, Manohar Shroff, Derek Stephens

  • 1Division of Neurology, the Hospital for Sick Children, Toronto, Ontario, Canada.

Annals of Neurology
|May 4, 2010
PubMed

Insights

Anticoagulant therapy (ACT) appears safe for pediatric cerebral sinovenous thrombosis (CSVT). Untreated patients showed increased thrombus propagation, suggesting anticoagulants should be strongly considered for pediatric CSVT.

Area of Science:

  • Neurology
  • Pediatric Medicine
  • Hematology

Background:

  • Pediatric cerebral sinovenous thrombosis (CSVT) lacks robust clinical trial data.
  • Anticoagulant therapy (ACT) is increasingly used in pediatric CSVT, often based on adult studies.
  • Safety and outcome data for ACT in pediatric CSVT are critically needed.

Purpose of the Study:

  • To assess the safety and clinical outcomes of anticoagulant therapy (ACT) in neonates and children diagnosed with CSVT.
  • To evaluate the impact of ACT on intracranial hemorrhage, thrombus propagation, and recanalization in pediatric CSVT patients.

Main Methods:

  • A single-center prospective study involving neonates and children with CSVT.
  • Standardized ACT protocols (heparin, warfarin) were administered.
  • Neuroimaging and the Pediatric Stroke Outcome Measure were used to assess safety and outcomes.

Main Results:

  • Among 162 patients, 85 received ACT. Major hemorrhage occurred in 6% of treated patients, all nonfatal.
  • Thrombus propagation was significantly lower in treated versus untreated patients (neonates: 4% vs 28%; children: 7% vs 37%).
  • Favorable clinical outcomes were observed in 50% of ACT-treated patients, with earlier and more complete recanalization in neonates.

Conclusions:

  • Anticoagulant therapy (ACT) is deemed safe in pediatric CSVT.
  • Nontreatment with ACT is associated with significant thrombus propagation.
  • ACT should be strongly considered for managing pediatric CSVT due to its safety and efficacy in preventing propagation.
Abstract

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