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Anticoagulant therapy in head injury-associated cerebral sinovenous thrombosis in children

Authors

  • Frederico Xavier MD,

    1. Thrombosis Service, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
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  • Patcharee Komvilaisak MD,

    1. Thrombosis Service, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
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  • Suzan Williams MD, FRCPC,

    1. Thrombosis Service, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
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  • Abhaya V. Kulkarni MD, FRCSC,

    1. Division of Neurosurgery, The Hospital for Sick Children and University of Toronto, Ontario, Canada
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  • Gabrielle deVeber MD, MHSc, FRCPC,

    1. Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
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  • Mahendranath D. Moharir MD, MSc, FRACP

    Corresponding author
    1. Pediatric Stroke Program, Division of Neurology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Ontario, Canada
    • Correspondence to: Mahendranath Moharir, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G1X8.

      E-mail: mahendranath.moharir@sickkids.ca

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  • Conflict of interest: Nothing to declare.

Abstract

Background

Head injury is a risk factor for cerebral sinovenous thrombosis (CSVT) in children. Literature concerning head injury-associated CSVT (HIA-CSVT) is scarce. Data supporting safety and efficacy of anticoagulant therapy (ACT) in childhood CSVT is emerging. However, intracranial hemorrhage (ICH) occurs frequently in children with HIA-CSVT at diagnosis making initiation of ACT controversial due to the fear of worsening of ICH.

Procedure

We conducted a retrospective descriptive review of a consecutive cohort of children with HIA-CSVT from 1998 to 2012.

Results

Twenty patients (14 males, mean age 7 years) with HIA-CSVT were identified. Most (19/20 [95%]) had significant ICH at diagnosis. None received ACT at diagnosis. Fourteen (70%) were later (median 7 days post-trauma, range 2–48 days) treated with ACT due to CSVT persistence (nine) and propagation (five), despite ICH in 13. None of the treated patients, including the 13 with pre-existing ICH, had significant worsening of hemorrhage. Three (21%) treated patients had minor asymptomatic extension of their hemorrhage and further ACT was withheld. No patient died while on ACT. No patient experienced CSVT propagation on ACT. Clinical outcomes were normal (no neurologic deficits) in 5/20(25%), mild neurological deficits in 10/20(50%), and moderate-severe neurological deficits in 5/20(25%). Small sample size did not permit assessment of the effect of ACT on outcome.

Conclusions

Anticoagulant therapy is safe in selected children with HIA-CSVT. ICH is not an absolute contraindication to ACT in children with HIA-CSVT. Pediatr Blood Cancer 2014;61:2037–2042. © 2014 Wiley Periodicals, Inc.

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