Anticoagulants achieve favourable outcomes for kids with infection-related CVT

Children with central venous thrombosis (CVT) and associated head or neck infections see good 3-month outcomes after treatment with therapeutic anticoagulants, according to a subgroup analysis of the EINSTEIN-Jr study.

EINSTEIN-Jr assessed 500 children with venous thrombosis treated with anticoagulants, of whom 114 had CVT. The present analysis focused on 74 children (median age 6 years, 62 percent boys) with both CVT and associated head or neck infections, monitoring for the outcome measures of bleeding and recurrent venous thromboembolic events.

All participants had been given antibiotics and therapeutic anticoagulants. Forty-one children (55 percent) underwent surgery, with 34 being diagnosed with CVT preoperatively. Anticoagulation was interrupted 0–1 day before surgery in 12 patients but was restarted after a median of 1 day postoperatively.

Both outcome measures occurred rarely, with only one child (1 percent) developing recurrent thrombosis and another (1 percent) experiencing a major bleeding event. Of note, neither complication was associated with surgery.

At the 3-month follow-up, three children (4 percent) showed persistent focal neurologic defects, while two (3 percent) had impaired vision. No deaths were reported.

“Children with CVT and an associated head or neck infection who were administered therapeutic anticoagulants had a favorable clinical outcome at 3 months, with low incidences of bleeding and thrombotic complications, despite surgical interventions with delay or interruption of anticoagulation in more than half of the children,” the researchers said.

“Further studies are needed to definitively establish the safety of anticoagulant treatment in children with infection-related CVT,” they added.