Anticoagulants therapy in pediatric cerebral venous sinus thrombosis

Abstract

Objective To explore the clinical efficacy and long-term outcomes of anticoagulants therapy in pediatric cerebral venous sinus thrombosis (CVST). Methods 58 CVST children aged 1 month to 16 years received an standardized anticoagulant therapy of low molecular weight heparin, warfarin and urokinase.Initial and follow-up neuroimages were evaluated for associated intracranial hemorrhage, thrombus propagation rate and long-term quality-of-life.And clinical outcome was assessed by the modified Rankin scale (mRS). Results Among them, 38/58 received anticoagulants at diagnosis.Major anticoagulation-associated hemorrhage occurred in 5.3% (2/38) and clinical outcome was favorable.Early follow-up imaging demonstrated thrombus propagation in 5/58 children (1/38 with and 4/20 without anticoagulation[P=0.023]). Five deaths were associated with CVST (1 with anticoagulation). The decreasing rate of mortality in CVST with anticoagulation was 25%-30%.Clinical outcomes of death and long-term worse prognosis were unfavorable in 22%(11/50). The clinical risk factors of long-term outcomes were full-term infant (OR[odd ratio]0.12, P=0.045), neuroimaging of multiple lesions (OR 15.16, P=0.042) and anticoagulation (OR 0.007, P=0.024). Initial intracranial hypertension was associated with neonatal asphyxia (OR 0.35, P=0.025), neuroimaging of multiple lesion (OR 8.73, P=0.048) and onset time (OR 0.89, P=0.003). Furthermore anticoagulation was probably helpful for CVST children in controlling subacute intracranial pressure (P=0.048). Conclusions In pediatric CVST with mild intracranial hemorrhage, anticoagulation is both safe and effective.And it may reduce the rate of mortality, enhance quality-of-life and improve long-term outcomes. Key words: Cranium; Venous sinus; Thrombosis; Comparative Study