Traumatic cerebral dural sinus vein thrombosis/stenosis in pediatric patients—is anticoagulation necessary?

Cerebral sinus venous thrombosis in children with inherited bleeding disorders: A case series

“…5,10,25 As patients 2, 3, and 4 had CSVT resolution without anticoagulation, watchful observation may be an alternative approach for managing CSVT in these patients, especially in the setting of ICH and lack of severe features of CSVT such as focal neurologic signs and venous infarcts, with anticoagulation reserved for worsening clinical and/or imaging findings of CSVT. 8 Prospective studies are required to determine the risks and outcomes associated with withholding versus administering anticoagulation therapy in pediatric patients with inherited BDs and CSVT.…”

“…Pediatric studies in CSVT following trauma with ICH indicate that anticoagulation therapy may be safe with close monitoring and without worsening of ICH, although as mentioned in pediatric CHEST guidelines, withholding anticoagulation therapy with watchful waiting and imaging surveillance is an appropriate alternative in certain cases, as thrombi can resolve spontaneously due to physiologic processes including fibrinolysis 5,10,25 . As patients 2, 3, and 4 had CSVT resolution without anticoagulation, watchful observation may be an alternative approach for managing CSVT in these patients, especially in the setting of ICH and lack of severe features of CSVT such as focal neurologic signs and venous infarcts, with anticoagulation reserved for worsening clinical and/or imaging findings of CSVT 8 . Prospective studies are required to determine the risks and outcomes associated with withholding versus administering anticoagulation therapy in pediatric patients with inherited BDs and CSVT.…”

“…5 Literature regarding the treatment of CSVT is variable, with studies demonstrating good neurological outcomes and thrombus resolution without anticoagulation therapy as well as studies indicating CSVT propagation in over one-fourth to one-third of children not treated with anticoagulation therapy. [7][8][9] Studies are F I G U R E 1 Five-year-old patient, later found to have hemophilia A, presented to the emergency department (ED) due to head trauma. (A) Computed tomography (CT) of the head after admission shows parieto-occipital hematoma (indicated by arrow).…”

“…As recommended by CHEST guidelines, pediatric hematologists should have an active role in the medical team when managing patients requiring thromboembolism treatment 5 . Literature regarding the treatment of CSVT is variable, with studies demonstrating good neurological outcomes and thrombus resolution without anticoagulation therapy as well as studies indicating CSVT propagation in over one‐fourth to one‐third of children not treated with anticoagulation therapy 7–9 . Studies are also conflicting regarding the risk of worsening pretreatment ICH with anticoagulation therapy for CSVT 9,10 .…”

Refractory Elevated Intracranial Pressure (ICP) in the Setting of a Traumatic Cerebral Sinus Venous Thrombosis (CSVT)

“…The optimal timing of initiation of systemic anticoagulation is challenging due to a lack of clear guidelines and potentially devastating consequences of hemorrhage expansion. Some authors recommend initial expectant management especially in children and when ICP is stable [8], while others recommend early therapeutic anticoagulation within 48 hours of injury if ICHs are stable [9]. The duration of anticoagulation for traumatic CSVT is also not well defined.…”