Ryan J Felling1, Sahar M A Hassanein1, Jennifer Armstrong1, Luis Aversa1, Lori Billinghurst1, Neil A Goldenberg1, Jo Ellen Lee1, Emily C Maxwell1, Michael J Noetzel1, Warren Lo1. 1. Division of Child Neurology (RJF), Department of Neurology and Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Pediatrics (SMAH), Faculty of Medicine, Ain Shams University, Egypt; Section of Child Neurology and Hemophilia and Thrombosis Center (JA, ECM), Department of Pediatrics, University of Colorado, Boulder; Department of Hematology (LA), Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina; Department of Neurology (LB), Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine; Divisions of Hematology (NAG), Departments of Pediatrics and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; All Children's Research Institute (NAG), Johns Hopkins All Children's Hospital, St. Petersburg, FL; Department of Neurology (JEL, WL), the Ohio State University and Nationwide Children's Hospital; College of Nursing (JEL), the Ohio State University, Columbus; Department of Neurology and Pediatrics (MJN), Washington University School of Medicine, St. Louis, MO; and Department of Pediatrics (WL), the Ohio State University and Nationwide Children's Hospital.
Abstract
OBJECTIVE: To test our hypothesis that anticoagulation is associated with better neurologic outcomes in childhood cerebral sinovenous thrombosis (CSVT), we analyzed treatment and outcomes in a population of 410 children from the International Pediatric Stroke Study (IPSS). METHODS: We included patients enrolled in the IPSS registry with a diagnosis of CSVT at age >28 days with radiologic confirmation, in isolation or with concomitant arterial ischemic stroke. The primary outcome was the neurologic status at discharge. We defined unfavorable outcome as severe neurologic impairment or death at discharge. The Pediatric Stroke Outcome Measure was used for long-term outcome in those with follow-up. Predictors of anticoagulation use and outcome were analyzed by logistic regression. RESULTS: Most children (95%) had identifiable risk factors, and 82% received anticoagulation. Shift analysis demonstrated better outcomes at discharge in children who were anticoagulated, and this persisted with longer-term outcomes. In multivariable analysis, anticoagulation was significantly associated with favorable outcomes (adjusted odds ratio [aOR] unfavorable 0.32, p = 0.007) whereas infarct was associated with unfavorable outcome (aOR unfavorable 6.71, p < 0.001). The trauma/intracranial surgery was associated with a lower odds of anticoagulation use (aOR 0.14, p < 0.001). CONCLUSIONS: Within the IPSS registry, children with risk factors of trauma or intracranial surgery were less likely to receive anticoagulation for CSVT. Anticoagulation was associated with a lower odds of severe neurologic impairment or death at hospital discharge, but this finding is limited and needs further confirmation in randomized, controlled, prospective studies.
OBJECTIVE: To test our hypothesis that anticoagulation is associated with better neurologic outcomes in childhood cerebral sinovenous thrombosis (CSVT), we analyzed treatment and outcomes in a population of 410 children from the International Pediatric Stroke Study (IPSS). METHODS: We included patients enrolled in the IPSS registry with a diagnosis of CSVT at age >28 days with radiologic confirmation, in isolation or with concomitant arterial ischemic stroke. The primary outcome was the neurologic status at discharge. We defined unfavorable outcome as severe neurologic impairment or death at discharge. The Pediatric Stroke Outcome Measure was used for long-term outcome in those with follow-up. Predictors of anticoagulation use and outcome were analyzed by logistic regression. RESULTS: Most children (95%) had identifiable risk factors, and 82% received anticoagulation. Shift analysis demonstrated better outcomes at discharge in children who were anticoagulated, and this persisted with longer-term outcomes. In multivariable analysis, anticoagulation was significantly associated with favorable outcomes (adjusted odds ratio [aOR] unfavorable 0.32, p = 0.007) whereas infarct was associated with unfavorable outcome (aOR unfavorable 6.71, p < 0.001). The trauma/intracranial surgery was associated with a lower odds of anticoagulation use (aOR 0.14, p < 0.001). CONCLUSIONS: Within the IPSS registry, children with risk factors of trauma or intracranial surgery were less likely to receive anticoagulation for CSVT. Anticoagulation was associated with a lower odds of severe neurologic impairment or death at hospital discharge, but this finding is limited and needs further confirmation in randomized, controlled, prospective studies.
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