TY - JOUR
T1 - Safety and efficacy of rivaroxaban in pediatric cerebral venous thrombosis (EINSTEIN-Jr CVT)
AU - Connor, Philip
AU - Sánchez van Kammen, Mayte
AU - Lensing, Anthonie W A
AU - Chalmers, Elizabeth
AU - Kállay, Krisztián
AU - Hege, Kerry
AU - Simioni, Paolo
AU - Biss, Tina
AU - Bajolle, Fanny
AU - Bonnet, Damien
AU - Grunt, Sebastian
AU - Kumar, Riten
AU - Lvova, Olga
AU - Bhat, Rukhmi
AU - Van Damme, An
AU - Palumbo, Joseph
AU - Santamaria, Amparo
AU - Saracco, Paola
AU - Payne, Jeanette
AU - Baird, Susan
AU - Godder, Kamar
AU - Labarque, Veerle
AU - Male, Christoph
AU - Martinelli, Ida
AU - Morales Soto, Michelle
AU - Motwani, Jayashree
AU - Shah, Sanjay
AU - Hooimeijer, Helene L
AU - Prins, Martin H
AU - Kubitza, Dagmar
AU - Smith, William T
AU - Berkowitz, Scott D
AU - Pap, Akos F
AU - Majumder, Madhurima
AU - Monagle, Paul
AU - Coutinho, Jonathan M
N1 - © 2020 by The American Society of Hematology.
PY - 2020/12/22
Y1 - 2020/12/22
N2 - Anticoagulant treatment of pediatric cerebral venous thrombosis has not been evaluated in randomized trials. We evaluated the safety and efficacy of rivaroxaban and standard anticoagulants in the predefined subgroup of children with cerebral venous thrombosis (CVT) who participated in the EINSTEIN-Jr trial. Children with CVT were randomized (2:1), after initial heparinization, to treatment with rivaroxaban or standard anticoagulants (continued on heparin or switched to vitamin K antagonist). The main treatment period was 3 months. The primary efficacy outcome, symptomatic recurrent venous thromboembolism (VTE), and principal safety outcome, major or clinically relevant nonmajor bleeding,were centrally evaluated by blinded investigators. Sinus recanalization on repeat brain imaging was a secondary outcome. Statistical analyses were exploratory. In total, 114 children with confirmed CVT were randomized. All children completed the follow-up. None of the 73 rivaroxaban recipients and 1 (2.4%; CVT) of the 41 standard anticoagulant recipients had symptomatic, recurrent VTE after 3 months (absolute difference, 2.4%; 95% confidence interval [CI], -2.6% to 13.5%). Clinically relevant bleeding occurred in 5 (6.8%; all nonmajor and noncerebral) rivaroxaban recipients and in 1 (2.5%; major [subdural] bleeding) standard anticoagulant recipient (absolute difference, 4.4%; 95% CI, -6.7% to 13.4%). Complete or partial sinus recanalization occurred in 18 (25%) and 39 (53%) rivaroxaban recipients and in 6 (15%) and 24 (59%) standard anticoagulant recipients, respectively. In summary, in this substudy of a randomized trial with a limited sample size, children with CVT treated with rivaroxaban or standard anticoagulation had a low risk of recurrent VTE and clinically relevant bleeding. This trial was registered at clinicaltrials.gov as #NCT02234843.
AB - Anticoagulant treatment of pediatric cerebral venous thrombosis has not been evaluated in randomized trials. We evaluated the safety and efficacy of rivaroxaban and standard anticoagulants in the predefined subgroup of children with cerebral venous thrombosis (CVT) who participated in the EINSTEIN-Jr trial. Children with CVT were randomized (2:1), after initial heparinization, to treatment with rivaroxaban or standard anticoagulants (continued on heparin or switched to vitamin K antagonist). The main treatment period was 3 months. The primary efficacy outcome, symptomatic recurrent venous thromboembolism (VTE), and principal safety outcome, major or clinically relevant nonmajor bleeding,were centrally evaluated by blinded investigators. Sinus recanalization on repeat brain imaging was a secondary outcome. Statistical analyses were exploratory. In total, 114 children with confirmed CVT were randomized. All children completed the follow-up. None of the 73 rivaroxaban recipients and 1 (2.4%; CVT) of the 41 standard anticoagulant recipients had symptomatic, recurrent VTE after 3 months (absolute difference, 2.4%; 95% confidence interval [CI], -2.6% to 13.5%). Clinically relevant bleeding occurred in 5 (6.8%; all nonmajor and noncerebral) rivaroxaban recipients and in 1 (2.5%; major [subdural] bleeding) standard anticoagulant recipient (absolute difference, 4.4%; 95% CI, -6.7% to 13.4%). Complete or partial sinus recanalization occurred in 18 (25%) and 39 (53%) rivaroxaban recipients and in 6 (15%) and 24 (59%) standard anticoagulant recipients, respectively. In summary, in this substudy of a randomized trial with a limited sample size, children with CVT treated with rivaroxaban or standard anticoagulation had a low risk of recurrent VTE and clinically relevant bleeding. This trial was registered at clinicaltrials.gov as #NCT02234843.
UR - http://www.scopus.com/inward/record.url?scp=85098051228&partnerID=8YFLogxK
U2 - https://doi.org/10.1182/bloodadvances.2020003244
DO - https://doi.org/10.1182/bloodadvances.2020003244
M3 - Article
C2 - 33351120
SN - 2473-9529
VL - 4
SP - 6250
EP - 6258
JO - Blood advances
JF - Blood advances
IS - 24
ER -