Skip to main content
SpringerLink
Log in

Anticoagulation and Thrombolysis in the Pediatric Population

  • Chapter
  • First Online:
Pediatric Vascular Neurosurgery

  • 657 Accesses

Abstract

Pediatric stroke is an underestimated disease process that affects 3–15/100,000 children per year. There are distinct etiologies that are more common in the pediatric population. Risk factors affecting this population include vasculopathies, congenital heart diseases, sickle cell anemia, and some metabolic disorders. The three primary disease processes that warrant specific discussion with respect to anticoagulation and thrombolysis-thrombectomy include ischemic stroke, cerebral venous sinus thrombosis, and hemorrhagic stroke. Current recommendations for anticoagulation and endovascular therapy are based on treatment for adults and center on antithrombotic therapy. Antiplatelet therapy and heparin therapy have been recommended across-the-board. The role of mechanical thrombolysis–thrombectomy in the treatment of pediatric stroke has increased with the development of more devices for this therapeutic approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

CVT:

Cerebral venous sinus thrombosis

GP:

Glycoprotein

IA:

Intra-arterial

ICH:

Intracranial hemorrhage

IV:

Intravenous

LMWH:

Low-molecular weight heparin

UFH:

Ultra-fractionated heparin

References

  1. Simma B, Holiner I, Luetschg J. Therapy in pediatric stroke. Eur J Pediatr. 2013;172:867–75.

    Article  CAS  PubMed  Google Scholar 

  2. Sinclair AJ, Fox CK, Ichord RN, Almond CS, Bernard TJ, Beslow LA, Chan AK, Cheung M, deVeber G, Dowling MM, Friedman N, Giglia TM, Guilliams KP, Humpl T, Licht DJ, Mackay MT, Jordan LC. Stroke in children with cardiac disease: report from the International Pediatric Stroke Study Group Symposium. Pediatr Neurol. 2015;52:5–15.

    Article  PubMed  Google Scholar 

  3. World Health Organization: stroke, cerebrovascular accident. http://www.who.int/topics/cerebrovascular_accident/en/Accessed. 10 Sept 2015.

  4. Agrawal N, Johnston SC, Wu YW, Sidney S, Fullerton HJ. Imaging data reveal a higher pediatric stroke incidence than prior US estimates. Stroke. 2009;40:3415–21.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Bigi S, Fischer U, Wehrli E, Mattle HP, Boltshauser E, Burki S, Jeannet PY, Fluss J, Weber P, Nedeltchev K, El-Koussy M, Steinlin M, Arnold M. Acute ischemic stroke in children versus young adults. Ann Neurol. 2011;70:245–54.

    Article  PubMed  Google Scholar 

  6. deVeber G, Kirkham F. Guidelines for the treatment and prevention of stroke in children. Lancet Neurol. 2008;7:983–5.

    Article  PubMed  Google Scholar 

  7. Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D, Investigators E. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317–29.

    Article  CAS  PubMed  Google Scholar 

  8. Tsivgoulis G, Horton JA, Ness JM, Patterson D, Brethour M, Abanses JC, Alexandrov AV. Intravenous thrombolysis followed by intra-arterial thrombolysis and mechanical thrombectomy for the treatment of pediatric ischemic stroke. J Neurol Sci. 2008;275:151–3.

    Article  CAS  PubMed  Google Scholar 

  9. Wasay M, Bakshi R, Kojan S, Bobustuc G, Dubey N, Unwin DH. Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis. Stroke. 2001;32:2310–7.

    Article  CAS  PubMed  Google Scholar 

  10. deVeber G. Arterial ischemic strokes in infants and children: an overview of current approaches. Semin Thromb Hemost. 2003;29:567–73.

    Article  PubMed  Google Scholar 

  11. Janjua N, Nasar A, Lynch JK, Qureshi AI. Thrombolysis for ischemic stroke in children: data from the nationwide inpatient sample. Stroke. 2007;38:1850–4.

    Article  PubMed  Google Scholar 

  12. Kenet G, Lutkhoff LK, Albisetti M, Bernard T, Bonduel M, Brandao L, Chabrier S, Chan A, deVeber G, Fiedler B, Fullerton HJ, Goldenberg NA, Grabowski E, Gunther G, Heller C, Holzhauer S, Iorio A, Journeycake J, Junker R, Kirkham FJ, Kurnik K, Lynch JK, Male C, Manco-Johnson M, Mesters R, Monagle P, van Ommen CH, Raffini L, Rostasy K, Simioni P, Strater RD, Young G, Nowak-Gottl U. Impact of thrombophilia on risk of arterial ischemic stroke or cerebral sinovenous thrombosis in neonates and children: a systematic review and meta-analysis of observational studies. Circulation. 2010;121:1838–47.

    Article  PubMed  Google Scholar 

  13. Strater R, Becker S, von Eckardstein A, Heinecke A, Gutsche S, Junker R, Kurnik K, Schobess R, Nowak-Gottl U. Prospective assessment of risk factors for recurrent stroke during childhood – a 5-year follow-up study. Lancet. 2002;360:1540–5.

    Article  PubMed  Google Scholar 

  14. Young G, Albisetti M, Bonduel M, Brandao L, Chan A, Friedrichs F, Goldenberg NA, Grabowski E, Heller C, Journeycake J, Kenet G, Krumpel A, Kurnik K, Lubetsky A, Male C, Manco-Johnson M, Mathew P, Monagle P, van Ommen H, Simioni P, Svirin P, Tormene D, Nowak-Gottl U. Impact of inherited thrombophilia on venous thromboembolism in children: a systematic review and meta-analysis of observational studies. Circulation. 2008;118:1373–82.

    Article  PubMed  Google Scholar 

  15. Strater R, Kurnik K, Heller C, Schobess R, Luigs P, Nowak-Gottl U. Aspirin versus low-dose low-molecular-weight heparin: antithrombotic therapy in pediatric ischemic stroke patients: a prospective follow-up study. Stroke. 2001;32:2554–8.

    Article  CAS  PubMed  Google Scholar 

  16. Tomkowski WZ, Dybowska M, Kuca P, Gralec R, Burakowski J. The inefficacy of enoxaparin prophylaxis in a patient with congenital antithrombin deficiency. Clin Appl Thromb Hemost. 2009;15:241.

    Article  PubMed  Google Scholar 

  17. Goldenberg NA, Bernard TJ, Fullerton HJ, Gordon A, deVeber G. Antithrombotic treatments, outcomes, and prognostic factors in acute childhood-onset arterial ischaemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;8:1120–7.

    Article  CAS  PubMed  Google Scholar 

  18. Roach ES, Golomb MR, Adams R, Biller J, Daniels S, Deveber G, Ferriero D, Jones BV, Kirkham FJ, Scott RM, Smith ER, American Heart Association Stroke Council and the Council on Cerebrovascular Disease in the Young. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008;39:2644–91.

    Article  PubMed  Google Scholar 

  19. Amille-Lefond C, deVeber G, Chan A, Benedict S, Bernard T, Carpented J, Dowling M, Fullerton H, Hovinga C, Kirton A, Lo W, Zamel K, Ichord R. Use of alteplase in childhood arterial ischemic stroke: a multicentre, observational, cohort study. Lancet Neurol. 2009;9:530–6.

    Article  Google Scholar 

  20. Manco-Johnson MJ. How I treat venous thrombosis in children. Blood. 2006;107:21–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Sebire G, Tabarki B, Saunders DE, Leroy I, Liesner R, Saint-Martin C, Husson B, Williams AN, Wade A, Kirkham FJ. Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain. 2005;128:477–89.

    Article  CAS  PubMed  Google Scholar 

  22. Moharir MD, Shroff M, Stephens D, Pontigon AM, Chan A, MacGregor D, Mikulis D, Adams M, deVeber G. Anticoagulants in pediatric cerebral sinovenous thrombosis: a safety and outcome study. Ann Neurol. 2010;67:590–9.

    CAS  PubMed  Google Scholar 

  23. Modi K, Misra V, Reddy P. Rheolytic thrombectomy for dural venous sinus thrombosis. J Neuroimaging. 2009;19:366–9.

    Article  PubMed  Google Scholar 

  24. Rammos SK, Phillips J, Lin J, Moresco K, Meagher S. Successful rheolytic mechanical thrombectomy of cerebral venous thrombosis in a pediatric patient. J Neurosurg Pediatr. 2013;11:140–3.

    Article  PubMed  Google Scholar 

  25. Rottger C, Madlener K, Heil M, Gerriets T, Walberer M, Wessels T, Bachmann G, Kaps M, Stolz E. Is heparin treatment the optimal management for cerebral venous thrombosis? Effect of abciximab, recombinant tissue plasminogen activator, and enoxaparin in experimentally induced superior sagittal sinus thrombosis. Stroke. 2005;36:841–6.

    Article  PubMed  Google Scholar 

  26. Stam J, Majoie CB, van Delden OM, van Lienden KP, Reekers JA. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study. Stroke. 2008;39:1487–90.

    Article  PubMed  Google Scholar 

  27. Kulcsar Z, Marosfoi M, Berentei Z, Szikora I. Continuous thrombolysis and repeated thrombectomy with the Penumbra System in a child with hemorrhagic sinus thrombosis: technical note. Acta Neurochir (Wien). 2010;152:911–6.

    Article  Google Scholar 

  28. Scott JA, Pascuzzi RM, Hall PV, Becker GJ. Treatment of dural sinus thrombosis with local urokinase infusion. Case Report J Neurosurg. 1988;68:284–7.

    CAS  PubMed  Google Scholar 

  29. Bose A, Henkes H, Alfke K, Reith W, Mayer TE, Berlis A, Branca V, Sit SP, Penumbra Phase 1 Stroke Trial I. The Penumbra System: a mechanical device for the treatment of acute stroke due to thromboembolism. AJNR Am J Neuroradiol. 2008;29:1409–13.

    Article  CAS  PubMed  Google Scholar 

  30. Formaglio M, Catenoix H, Tahon F, Mauguiere F, Vighetto A, Turjman F. Stenting of a cerebral venous thrombosis. J Neuroradiol. 2010;37:182–4.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Kunal Vakharia MD, Hakeem J. Shakir MD & Elad I. Levy MD, MBA

  2. Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, 100 High Street, Suite B4, Buffalo, NY, USA

    Kunal Vakharia MD, Hakeem J. Shakir MD & Elad I. Levy MD, MBA

  3. Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA

    Elad I. Levy MD, MBA

  4. Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, NY, USA

    Elad I. Levy MD, MBA

Authors
  1. Kunal Vakharia MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hakeem J. Shakir MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Elad I. Levy MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elad I. Levy MD, MBA .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA

    Abhishek Agrawal

  2. Department of Neurosurgery, Methodist Neurological Institute, Houston, Texas, USA

    Gavin Britz

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Vakharia, K., Shakir, H.J., Levy, E.I. (2016). Anticoagulation and Thrombolysis in the Pediatric Population. In: Agrawal, A., Britz, G. (eds) Pediatric Vascular Neurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-43636-4_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-43636-4_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43634-0

  • Online ISBN: 978-3-319-43636-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation