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Anticoagulation therapy in pediatric patients with sinovenous thrombosis: a cohort study
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
Insights
This pilot study suggests low-molecular-weight heparin (LMWH) is a safe treatment for pediatric sinovenous thrombosis (SVT). Further randomized trials are needed to confirm LMWH efficacy in children with SVT.
Area of Science:
- Pediatric Neurology
- Hematology
- Vascular Medicine
Background:
- Sinovenous thrombosis (SVT) is a serious condition in children.
- Anticoagulant therapy is a potential treatment, but its safety and efficacy in pediatric SVT require further investigation.
Purpose of the Study:
- To assess the safety and use of anticoagulant therapy in children diagnosed with sinovenous thrombosis (SVT).
Main Methods:
- A pilot study was conducted at a single institution from 1992-1996.
- Consecutive children diagnosed with SVT via various imaging techniques were evaluated for anticoagulant therapy.
- Radiographic evaluations included CT, MRI with venography, and ultrasonography.
Main Results:
- Thirty children experienced 32 episodes of SVT; the median age was 6.2 years.
- Ten children received standard heparin, and 12 received low-molecular-weight heparin (LMWH).
- No intracranial hemorrhage occurred in the LMWH group, compared to one silent bleed in the standard heparin group.
Conclusions:
- Anticoagulant therapy, particularly LMWH, appears safe for treating pediatric SVT.
- LMWH may play a significant role in managing children with SVT.
- A randomized controlled trial is recommended to validate these findings.
Objective:
To assess the use of anticoagulant therapy in a consecutive cohort study of children with sinovenous thrombosis (SVT).
Methods:
A single institutional pilot study of anticoagulant therapy was conducted from January 1992 to December 1996 at the Hospital for Sick Children, Toronto, Ontario. Consecutive children with the diagnosis of SVT, made by computed tomography, magnetic resonance imaging (MRI), MRI with venography, ultrasonography, nuclear brain scanning, or conventional angiography were eligible for anticoagulant therapy. RADIOGRAPHIC EVALUATION: Most children underwent multiple radiographic tests for evaluation of the central nervous system. Of the 32 episodes of SVT, CT was performed in 30, MRI with or without venography in 26, ultrasonography in 11, and nuclear brain scanning in 5. The majority of the SVTs were located at the superior sagittal sinus (50%) and right lateral sinus complex (44%).
Results:
There were 30 consecutive children with 32 episodes of SVT during the 5-year study (2 girls had recurrent SVT). The median age was 6.2 years (age range, 3 days to 18 years), and the sex of the patients was evenly distributed (15 girls and 15 boys). The primary associated clinical conditions consisted of systemic lupus erythematosus (n = 5), renal disease (n = 3), perinatal distress (n = 2), congenital heart disease (n = 1), cerebral arteriovenous malformation (n = 1), and neurosurgery for refractory seizures (n= 1). The remainder were previously healthy children older than 1 month (n = 10) and newborns (n = 7). Eight children were ineligible for anticoagulant therapy because of an associated intracranial hemorrhage (n = 6), a postoperative bleeding risk after neurosurgery (n = 1), or a prolonged delay from the diagnosis to the time of referral (n = 1). Ten children received standard heparin, and 12 children received low-molecular-weight heparin (LMWH) (enoxaparin sodium). Eighteen children were treated with oral anticoagulants for 3 months after initial heparin therapy, and 4 patients received LMWH for the entire course of treatment. There was no intracranial hemorrhage in the 12 patients treated with LMWH, but there was 1 case of clinically silent bleeding in the standard heparin group.
Conclusions:
The results of this pilot study suggest that anticoagulant therapy, in particular LMWH, is safe and may have a role in the treatment of children with SVT. A randomized controlled trial is warranted.