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Anticoagulation for Septic Cerebral Venous Thrombosis in Childhood
Hareen Seerha1, Kristin Maher2, Dwight Barry3
1Bozeman Foundations, School of Medicine, University of Washington.
Insights
Anticoagulation appears safe for children with septic cerebral venous thrombosis (CVT), showing no bleeding complications. Further research is needed to confirm if it improves outcomes in these cases.
Area of Science:
- Pediatric Neurology
- Hematology
- Infectious Diseases
Background:
- Cerebral venous thrombosis (CVT) in children typically warrants anticoagulation.
- Septic CVT, associated with head/neck infections, traditionally advises against anticoagulation.
- Current practice involves controversy, with many septic CVT patients receiving anticoagulation due to concerns about thrombus progression.
Purpose of the Study:
- To evaluate the safety and outcomes of anticoagulation in children with septic CVT.
- To assess bleeding complications and thrombus resolution rates in this patient group.
Main Methods:
- Retrospective study of 40 children with septic CVT at Seattle Children's Hospital (2009-2023).
- Analysis of anticoagulation use, bleeding complications, and thrombus resolution via follow-up venous imaging.
- Evaluation of outcomes at 1 and 3 months post-diagnosis.
Main Results:
- 25 out of 40 (63%) children with septic CVT received anticoagulation.
- No bleeding complications were observed in patients who received anticoagulation.
- At 1 month, 26% of evaluable patients showed thrombus resolution; at 3 months, 77% showed resolution.
- Thrombus persistence was observed in 74% at 1 month and 23% at 3 months.
Conclusions:
- Anticoagulation is a safe treatment option for children with septic CVT, evidenced by the absence of bleeding complications.
- The study supports the safety of anticoagulation but highlights the need for further investigation into its efficacy in improving outcomes for septic CVT.
Abstract:
Anticoagulation is recommended for most children with cerebral venous thrombosis (CVT) to prevent venous infarction and promote recanalization. An exception is CVT associated with head and neck infection (septic CVT), for which treatment of infection without concomitant use of anticoagulation is recommended. Despite this, the use of anticoagulation in septic CVT is controversial, and children with septic CVT are often anticoagulated due to concerns about thrombus progression and persistence despite infection treatment. A retrospective study of children with septic CVT cared for at Seattle Children's Hospital between 2009 and 2023 was conducted to assess the safety and outcome of anticoagulation. Among 40 children with septic CVT, 25 (63%) received anticoagulation. None had bleeding complications. Performance of follow-up venous imaging was inconsistent and more commonly pursued in patients treated with anticoagulation. A total of 23/40 (58%) patients were evaluable at 1 month, among whom 26% (6/23) had resolution of thrombus and 74% (17/23) had persistence. A total of 22/40 (55%) patients were evaluable at 3 months, among whom 77% (17/22) had resolution of thrombus and 23% (5/22) had persistence. This supports the safety of anticoagulation, but further studies are needed to determine whether anticoagulation improves outcomes after septic CVT.
