Anticoagulation therapy in pediatric patients with sinovenous thrombosis -A cohort study

Objective: To assess the use of anticoagulant therapy in a consecutive coho rt study of children with sinovenous thrombosis (SVT). Methods: A single institutional pilot study of anticoagulant therapy was co nducted from January 1992 to December 1996 at the Hospital for Sick Childre n, Toronto, Ontario. Consecutive children with the diagnosis of SVT, made b y computed tomography, magnetic resonance imaging (MRI), MRI with venograph y, ultrasonography, nuclear brain scanning, or conventional angiography wer e eligible for anticoagulant therapy. Radiographic Evaluation: Most children underwent multiple radiographic test s 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, ultrasonograp hy in 11, and nuclear brain scanning in 5. The majority of the SVTs were lo cated 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 dis tributed (15 girls and 15 boys). The primary associated clinical conditions consisted of systemic lupus erythematosus (n=5), renal disease (n=3), peri natal distress (n=2), congenital heart disease (n=1), cerebral arteriovenou s malformation (n=1), and neurosurgery for refractory seizures (n=1). The r emainder were previously healthy children older than 1 month (n=10) and new borns (n=7). Eight children were ineligible for anticoagulant therapy becau se 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 trea ted with LMWH, but there was 1 case of clinically silent bleeding in the st andard heparin group. Conclusions: The results of this pilot study suggest that anticoagulant the rapy, in particular LMWH, is safe and may have a role in the treatment of c hildren with SVT. A randomized controlled trial is warranted.