Felling Ryan J, Hassanein Sahar M A, Armstrong Jennifer, Aversa Luis, Billinghurst Lori, Goldenberg Neil A, Lee Jo Ellen, Maxwell Emily C, Noetzel Michael J, Lo Warren
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.
Neurol Clin Pract. 2020 Jun;10(3):232-244. doi: 10.1212/CPJ.0000000000000720.
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).
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.
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, = 0.007) whereas infarct was associated with unfavorable outcome (aOR unfavorable 6.71, < 0.001). The trauma/intracranial surgery was associated with a lower odds of anticoagulation use (aOR 0.14, < 0.001).
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.
为验证我们的假设，即抗凝治疗与儿童脑静脉窦血栓形成（CSVT）更好的神经学预后相关，我们分析了国际儿童卒中研究（IPSS）中410名儿童的治疗情况及预后。
我们纳入了IPSS登记处中年龄>28天、经影像学确诊为孤立性或合并动脉缺血性卒中的CSVT患者。主要结局是出院时的神经学状态。我们将不良结局定义为出院时严重神经功能障碍或死亡。对有随访的患者使用儿童卒中结局量表评估长期预后。通过逻辑回归分析抗凝治疗的使用及预后的预测因素。
大多数儿童（95%）有可识别的危险因素，82%接受了抗凝治疗。移位分析显示接受抗凝治疗的儿童出院时预后更好，且这种情况在长期预后中持续存在。在多变量分析中，抗凝治疗与良好结局显著相关（调整后的优势比[aOR] 不良结局为0.32，P = 0.007），而梗死与不良结局相关（aOR 不良结局为6.71，P < 0.001）。创伤/颅内手术与抗凝治疗使用几率较低相关（aOR 0.14，P < 0.001）。
在IPSS登记处中，有创伤或颅内手术危险因素的儿童因CSVT接受抗凝治疗的可能性较小。抗凝治疗与出院时严重神经功能障碍或死亡几率较低相关，但这一发现有限，需要在随机、对照、前瞻性研究中进一步证实。
