Anticoagulation Therapy in Pediatric Patients With Sinovenous Thrombosis: A Cohort Study | Clinical Pharmacy and Pharmacology | JAMA Neurology | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Schoenberg  BMellinger  JSchoenberg  D Cerebrovascular disease in infants and children: a study of incidence, clinical features, and survival.  Neurology. 1978;28763- 768Google ScholarCrossref
Broderick  JTalbot  TPrenger  ELeach  ABrott  T Stroke in children within a major metropolitan area: the surprising importance of intracerebral hemorrhage.  J Child Neurol. 1993;8250- 255Google ScholarCrossref
Roach  ESRiela  AR Pediatric Cerebrovascular Disorders. 2nd ed. Armonk, NY Futura Publishing Co Inc1995;
Lee  BVoorhies  TEhrlich  MLipper  EAuld  PVannucci  R Digital intravenous cerebral angiography in neonates.  AJNR Am J Neuroradiol. 1984;5281- 286Google Scholar
Towbin  A Central nervous system damage in the human fetus and newborn infant: mechanical and hypoxic injury incurred in the fetal-neonatal period.  Am J Dis Child. 1970;119529- 542Google ScholarCrossref
Rivkin  MAnderson  MKaye  E Neonatal idiopathic cerebral venous thrombosis: an unrecognized cause of transient seizures or lethargy.  Ann Neurol. 1992;3251- 56Google ScholarCrossref
Shevell  MISilver  KO'Gorman  AMWaters  GVMontes  JL Neonatal dural sinus thrombosis.  Pediatr Neurol. 1989;5161- 165Google ScholarCrossref
Ameri  ABousser  M Cerebral venous thrombosis.  Neurol Clin. 1992;1087- 111Google Scholar
deVeber  GAndrew  MAdams  M  et al.  Treatment of pediatric sinovenous thrombosis with low molecular weight heparin [abstract].  Ann Neurol. 1995;38S32Google Scholar
Einhaupl  KMVillringer  AMeister  W  et al.  Heparin treatment in sinus venous thrombosis.  Lancet. 1991;338597- 600Google ScholarCrossref
Massicotte  PAdams  MMarzinotto  VBrooker  LAndrew  M Low molecular weight heparin in pediatric patients with thrombotic disease: a dose finding study.  J Pediatr. 1996;128313- 318Google ScholarCrossref
Andrew  MMarzinotto  VBlanchette  V  et al.  Heparin therapy in pediatric patients: a prospective cohort study.  Pediatr Res. 1994;3578- 83Google ScholarCrossref
Hirsh  J Heparin.  N Engl J Med. 1991;3241565- 1574Google ScholarCrossref
Cruickshank  MLevine  MHirsh  JRoberts  RSiguenza  M A standard heparin nomogram for the management of heparin therapy.  Arch Intern Med. 1991;151333- 337Google ScholarCrossref
Andrew  MMarzinotto  VBrooker  L  et al.  Oral anticoagulant therapy in pediatric patients: a prospective study.  Thromb Haemost. 1994;71265- 269Google Scholar
deVeber  GAdams  MAndrew  Mand the Canadian Pediatric Neurologists, Canadian Pediatric Ischemic Stroke Registry (Analysis III).  Can J Neurol Sci. 1995;22(suppl 1)S21- S24Google Scholar
Einhaupl  KMVillringer  AHaberl  RL  et al.  Clinical spectrum of sinus venous thrombosis. Einhaupl  KKempski  OBaethmann  Aeds Cerebral Sinus Thrombosis Experimental and Clinical Aspects. New York, NY Plenum Press1990;149- 155Google Scholar
Linker  AHovingh  P Isolation and characterization of oligosaccharides obtained from heparin by the action of heparinase.  Biochemistry. 1972;11563- 567Google ScholarCrossref
Hopwood  JHook  MLinker  ALindahl  U Anticoagulant activity of heparin: isolation of antithrombin-binding sites.  FEBS Lett. 1976;6951- 54Google ScholarCrossref
Lane  DMacGregor  IIvan  RCella  GKakkar  V Molecular weight dependence of the anticoagulant properties of heparin: intravenous and subcutaneous administration of fractionated heparins to man.  Thromb Res. 1979;16651- 662Google ScholarCrossref
Johnson  EKirkwood  TStirling  Y  et al.  Four heparin preparations: anti-Xa potentiating effects of heparin after subcutaneous injection.  Thromb Haemost. 1976;35586- 591Google Scholar
Bergqvist  DHedner  USjorin  EHolmer  E Anticoagulant effects of two types of low molecular weight heparin administered subcutaneously.  Thromb Res. 1983;32381- 391Google ScholarCrossref
Palm  MMattsson  C Pharmacokinetics of fragmin: a comparative study in the rabbit of its high and low affinity forms for antithrombin.  Thromb Res. 1987;4851- 62Google ScholarCrossref
Original Contribution
December 1998

Anticoagulation Therapy in Pediatric Patients With Sinovenous Thrombosis: A Cohort Study

Author Affiliations

From the Department of Pediatrics, McMaster University, Hamilton, Ontario (Drs deVeber, Chan, and Andrew), and the Divisions of Hematology (Drs Monagle, Massicotte, Leaker, and Andrew and Ms Marzinotto), Neurology (Dr deVeber), and Neuroradiology (Dr Armstrong), Hospital for Sick Children, Toronto, Ontario.

Arch Neurol. 1998;55(12):1533-1537. doi:10.1001/archneur.55.12.1533

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.