儿童创伤后脑静脉窦血栓形成：一项回顾性多中心研究

Post traumatic cerebral sinovenous thrombosis in children: A retrospective and multicenter study.

作者信息

Roth Helena, Ränsch Roman, Kossorotoff Manoelle, Chahine Adela, Tirel Olivier, Brossier David, Wroblewski Isabelle, Orliaguet Gilles, Chabrier Stéphane, Mortamet Guillaume

机构信息

Pediatric Intensive Care Unit, Grenoble-Alpes University Hospital, 38000, Grenoble, France.

French Centre for Paediatric Stroke, Pediatric Neurology Department, Necker-Enfants Maladies University Hospital, Assistance Publique Hôpitaux de Paris, 75015, Paris, France.

出版信息

Eur J Paediatr Neurol. 2023 Mar;43:12-15. doi: 10.1016/j.ejpn.2023.01.009. Epub 2023 Jan 25.

DOI:10.1016/j.ejpn.2023.01.009

PMID:36746017

Abstract

CONTEXT

Cerebral sinovenous thrombosis (CSVT) is a rare but life-threatening condition in the pediatric population and there is no pediatric guidelines regarding anticoagulation for post traumatic CSVT.

OBJECTIVE

This study aims to describe a cohort of children with post traumatic CSVT and the use of anticoagulant therapy in this population.

METHODS

A multicenter retrospective study. Patients admitted with post traumatic CSVT in the six participating Pediatric Intensive Care Unit were included.

RESULTS

Overall, 29 patients (median age 8.2 years [IQR 4.8-14.6], n = 22 (76%) males) were included in the study (Table 1). CSVT was observed within the first 24 h after admission for a half of the patients (n = 14, 50%). Anticoagulation was initiated in 18 patients (62%). No patient received thrombolytic therapy or endovascular treatment. The presence of epidural hematoma was associated with the absence of anticoagulation (n = 0 versus n = 10, p = 0.003). One patient (3%) died of extracranial injury (not related with adverse event of anticoagulation) and in survivors, median Pediatric Overall Performance Category Outcome (POPC) score at discharge from PICU was 2 [IQR 2-4] (i.e., mild disability). Regarding the outcomes of patients, we found no association according to the anticoagulation status (p = 1). Overall, 23 patients (79%) had a follow-up cerebral imaging with a median delay of 42 days [IQR 6-63] after admission. CSVT was still seen in 9 patients (31%). We found no difference regarding the persistence of CSVT between patients according to the anticoagulation status (p = 0.36). The median duration of anticoagulant treatment was 58 days [IQR 44-91] and one patient (3%) experienced adverse event related to anticoagulation.

CONCLUSION

There were minimal adverse events in patients with post traumatic CSVT treated with therapeutic anticoagulation. However, the effect of anticoagulation on outcomes needs to be confirmed in further studies.

摘要

背景

脑静脉窦血栓形成（CSVT）在儿科人群中虽罕见但危及生命，且尚无关于创伤后CSVT抗凝治疗的儿科指南。

目的

本研究旨在描述一组创伤后CSVT患儿及其在该人群中抗凝治疗的应用情况。

方法

一项多中心回顾性研究。纳入在六个参与研究的儿科重症监护病房收治的创伤后CSVT患者。

结果

总体而言，29例患者（中位年龄8.2岁[四分位间距4.8 - 14.6]，n = 22例（76%）为男性）纳入研究（表1）。一半患者（n = 14例，50%）在入院后24小时内观察到CSVT。18例患者（62%）开始抗凝治疗。无患者接受溶栓治疗或血管内治疗。硬膜外血肿的存在与未进行抗凝治疗相关（n = 0例对n = 10例，p = 0.003）。1例患者（3%）死于颅外损伤（与抗凝不良事件无关），在幸存者中，儿科重症监护病房出院时的中位儿科总体表现类别结局（POPC）评分为2[四分位间距2 - 4]（即轻度残疾）。关于患者的结局，我们未发现根据抗凝状态有相关性（p = 1）。总体而言，23例患者（79%）在入院后中位延迟42天[四分位间距6 - 63]进行了随访脑成像。9例患者（31%）仍可见CSVT。我们未发现根据抗凝状态患者之间CSVT持续存在情况有差异（p = 0.36）。抗凝治疗的中位持续时间为58天[四分位间距44 - 91]，1例患者（3%）经历了与抗凝相关的不良事件。