CEREBRAL SINOVENOUS THROMBOSIS IN CHILDREN: A STUDY OF SAFETY OF ANTICOAGULANT THERAPY

Objectives: Clinical trials are lacking in paediatric cerebral sinovenous thrombosis (CSVT). Based on adult studies, children are increasingly treated with anticoagulants. Data regarding anticoagulant therapy safety is required in children with CSVT.

Methods: Consecutive children (excluding neonates) with radiographically confirmed CSVT between January 1992 and January 2005 received anticoagulant treatment (standard/ low molecular weight heparin or warfarin) and were monitored for haemorrhage according to standardised institutional protocols. A study neuroradiologist blinded to treatment assessed initial and follow-up CT/MR venography for intracranial haemorrhage, extent and propagation or recanalization of thrombosis.

Results: In 77 children, 55/77(71%) were treated at diagnosis and 22/77(29%) were not. Reasons for non-treatment were hemorrhage in 14 and physician concern about risk of hemorrhage in 8 (meningitis, CNS tumor, low platelets, post-operative state etc.). Treatment was short-term in 85% (median 16 weeks), lifelong in 13% and unknown in 2%. In 3/55(5%) initially-treated children and 7/22 (32%) initially-untreated children, propagation of thrombosis was demonstrated in follow-up scans, leading to institution of anticoagulation in 5 of the initially-untreated children. Major bleeding occurred on treatment in 3/60 (5%) treated children and minor bleeding in 2/60 (3%) treated children. Recanalization was also assessed; by 3 to 6 months follow-up, no residual thrombus was seen in 42/73(57%) children, while some residual thrombus was seen in 27/73(38%). In 4/73(5%) insufficient data were available.

Conclusion: In children with CSVT current anticoagulant treatment appears safe. Nearly one-third (32%) of children not initially treated with anticoagulants in our study, showed propagation of initial thrombus. These findings together suggest that anticoagulants be strongly considered in paediatric CSVT. The dose, duration and types of anticoagulants require further study in clinical trials.