Author/Authors :
Gili Kenet، نويسنده , , Fenella Kirkham، نويسنده , , Thomas Niederstadt، نويسنده , , Achim Heinecke، نويسنده , , Dawn Saunders، نويسنده , , Monika Stoll، نويسنده , , Benjamin Brenner، نويسنده , , Christoph Bidlingmaier، نويسنده , , Christine Heller، نويسنده , , Ralf Kn?fler، نويسنده , , Rosemarie Schobess، نويسنده , , Barbara Zieger، نويسنده , , Guillaume Sébire، نويسنده , , Ulrike Nowak-G?ttl and the European Thromboses Study Group، نويسنده ,
Abstract :
Summary
Background
The relative importance of previous diagnosis and hereditary prothrombotic risk factors for cerebral venous thrombosis (CVT) in children in determining risk of a second cerebral or systemic venous thrombosis (VT), compared with other clinical, neuroimaging, and treatment variables, is unknown.
Methods
We followed up the survivors of 396 consecutively enrolled patients with CVT, aged newborn to 18 years (median 5•2 years) for a median of 36 months (maximum 85 months). In accordance with international treatment guidelines, 250 children (65%) received acute anticoagulation with unfractionated heparin or low-molecular weight heparin, followed by secondary anticoagulation prophylaxis with low-molecular weight heparin or warfarin in 165 (43%).
Results
Of 396 children enrolled, 12 died immediately and 22 (6%) had recurrent VT (13 cerebral; 3%) at a median of 6 months (range 0•1–85). Repeat venous imaging was available in 266 children. Recurrent VT only occurred in children whose first CVT was diagnosed after age 2 years; the underlying medical condition had no effect. In Cox regression analyses, non-administration of anticoagulant before relapse (hazard ratio [HR] 11•2 95% CI 3•4–37•0; p<0•0001), persistent occlusion on repeat venous imaging (4•1, 1•1–14•8; p=0•032), and heterozygosity for the G20210A mutation in factor II (4•3, 1•1–16•2; p=0•034) were independently associated with recurrent VT. Among patients who had recurrent VT, 70% (15) occurred within the 6 months after onset.
Conclusion
Age at CVT onset, non-administration of anticoagulation, persistent venous occlusion, and presence of G20210A mutation in factor II predict recurrent VT in children. Secondary prophylactic anticoagulation should be given on a patient-to-patient basis in children with newly identified CVT and at high risk of recurrent VT. Factors that affect recanalisation need further research.
