Treatment of pediatric cerebral venous sinus thromboses: the role of anticoagulation
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REVIEW ARTICLE
Treatment of pediatric cerebral venous sinus thromboses: the role of anticoagulation Nathan A. Shlobin 1 & Melissa A. LoPresti 2 & Molly Beestrum 3 & Sandi Lam 1 Received: 2 May 2020 / Accepted: 22 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Cerebral venous sinus thromboses (CVST) occur in children with a variety of etiologies. However, no standard treatment paradigm is established. We sought to identify what treatments have been applied, their outcomes, and the role of anticoagulation in pediatric patients with CVST. Methods A systematic review was conducted exploring all treatments of pediatric CVSTs using PubMed, Embase, Scopus, and Cochrane Library and Cochrane Central Register of Controlled Trials. Studies meeting inclusion criteria were reviewed in full and analyzed for study design, aim, population, interventions, and outcomes. Results Of 2946 resultant articles, 51 full-text articles were included. Management of infectious CVST included broad-spectrum antibiotics, surgery, and anticoagulation. Neoplastic and traumatic CVST treatment included anticoagulation. Treatment of CVSTs associated with metabolic abnormalities centered on correction of metabolic derangements, or supplementation where appropriate, and anticoagulation. Autoimmune, congenital, and thrombotic pathway CVSTs were treated with anticoagulation and treatment of the underlying disorder. Unfractionated heparin and low molecular weight heparin were most commonly used and seen to be effective and safe. Uncommonly, endovascular interventions including venous thrombectomy and intravenous injection of thrombolytic therapy were used with varying success. Conclusions While conservative, medical, thombolytic, endovascular, and surgical treatment all have a role in in the treatment of pediatric CVSTs, anticoagulation is commonly applied and found to be safe and effective in pediatrics. Risks and benefits of anticoagulation must be considered on an individual basis as no randomized trials have established a standard of care. Based on our findings, we propose an approach to CVST treatment and look to future study aimed at more clearly delineating treatment dose, duration, and timing of re-evaluation in these patients. Keywords Pediatric neurosurgery . Cerebral venous sinus thrombosis . Deep venous thrombosis . Sinus thrombus . Anticoagulation . Endovascular intervention
Introduction Cerebral venous sinus thrombosis (CVST) occurs in approximately 0.67 per 100,000 children per year [1], though the actual * Sandi Lam [email protected]; [email protected] 1
Department of Neurological Surgery, Division of Pediatric Neurosurgery, Anne and Robert H. Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, 225 E Chicago Ave, Box 28, Chicago, IL 60611, USA
2
Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
3
Department of Library Services, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
incidence is presumed higher as dia
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