TY - JOUR
T1 - Anticoagulant Treatment for Pediatric Infection-Related Cerebral Venous Thrombosis
AU - Sánchez van Kammen, Mayte
AU - Male, Christoph
AU - Connor, Philip
AU - Monagle, Paul
AU - Coutinho, Jonathan M.
AU - EINSTEIN-Jr CVT investigators
AU - Lensing, Anthonie W. A.
N1 - Funding Information: Funding: This study was supported by Bayer AG, Germany and Janssen Research & Development, United States. The funder was involved in the study design, data collection, analysis and interpretation of the data, writing of the report and decision to submit the article for publication. Data from the University Children's Hospital in Bern, Switzerland, were gathered with the help of the clinical trial unit PEDNET. Publisher Copyright: © 2021 The Author(s)
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background: We aimed to describe the clinical presentation, risk of bleeding and recurrent thrombosis, and perioperative anticoagulant management of children with cerebral venous thrombosis (CVT) and an associated head or neck infection. Methods: In this subgroup analysis of the EINSTEIN-Jr study, we included children with CVT and an associated head or neck infection who received therapeutic anticoagulants with either low-molecular-weight heparin (with or without subsequent vitamin K antagonists) or rivaroxaban for a period of 3 months. Analyses are descriptive. Results: Of 74 included children, 59 (80%) had otomastoiditis, 21 (28%) a central nervous system infection, 18 (24%) sinusitis, and 9 (12%) another upper respiratory tract infection; 29 (39%) had infection of multiple regions of the head or neck. All 74 children received antibiotics and therapeutic anticoagulants; 41 (55%) underwent surgery, of whom 34 were diagnosed with CVT preoperatively. Anticoagulation was started before surgery in 12 children and interrupted 0-1 days prior to surgery. Anticoagulation was (re)started in all 34 children at a median of 1 day (interquartile range: 0-1) postoperatively, in therapeutic doses in 94%. Overall, one child (1%, 95% confidence interval: 0-7) had recurrent thrombosis, and one (1%, 95% confidence interval: 0-7) had major bleeding; neither was associated with surgery. At 3 months, no children had died, 3 (4%) had persistent focal neurologic deficits, and 2 (3%) had impaired vision. Conclusions: Children with CVT and an associated head or neck infection administered therapeutic anticoagulants generally had low risks of bleeding and thrombotic complications, including those who had surgical interventions with delay or interruption of anticoagulation.
AB - Background: We aimed to describe the clinical presentation, risk of bleeding and recurrent thrombosis, and perioperative anticoagulant management of children with cerebral venous thrombosis (CVT) and an associated head or neck infection. Methods: In this subgroup analysis of the EINSTEIN-Jr study, we included children with CVT and an associated head or neck infection who received therapeutic anticoagulants with either low-molecular-weight heparin (with or without subsequent vitamin K antagonists) or rivaroxaban for a period of 3 months. Analyses are descriptive. Results: Of 74 included children, 59 (80%) had otomastoiditis, 21 (28%) a central nervous system infection, 18 (24%) sinusitis, and 9 (12%) another upper respiratory tract infection; 29 (39%) had infection of multiple regions of the head or neck. All 74 children received antibiotics and therapeutic anticoagulants; 41 (55%) underwent surgery, of whom 34 were diagnosed with CVT preoperatively. Anticoagulation was started before surgery in 12 children and interrupted 0-1 days prior to surgery. Anticoagulation was (re)started in all 34 children at a median of 1 day (interquartile range: 0-1) postoperatively, in therapeutic doses in 94%. Overall, one child (1%, 95% confidence interval: 0-7) had recurrent thrombosis, and one (1%, 95% confidence interval: 0-7) had major bleeding; neither was associated with surgery. At 3 months, no children had died, 3 (4%) had persistent focal neurologic deficits, and 2 (3%) had impaired vision. Conclusions: Children with CVT and an associated head or neck infection administered therapeutic anticoagulants generally had low risks of bleeding and thrombotic complications, including those who had surgical interventions with delay or interruption of anticoagulation.
KW - Anticoagulation
KW - Central nervous system infection
KW - Cerebral venous thrombosis
KW - Infection
KW - Otomastoiditis
KW - Sinusitis
UR - http://www.scopus.com/inward/record.url?scp=85122626959&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.pediatrneurol.2021.12.011
DO - https://doi.org/10.1016/j.pediatrneurol.2021.12.011
M3 - Article
C2 - 35032886
SN - 0887-8994
VL - 128
SP - 20
EP - 24
JO - Pediatric neurology
JF - Pediatric neurology
ER -