The value of anticoagulant therapy in a consecutive cohort 5 year study of 30 children with 32 episodes of sinovenous thrombosis (SVT) was assessed at the Hospital for Sick Children, Toronto, Canada. The median age was 6.2 years (range, 3 days to 18 years). Primary associated illnesses included systemic lupus erythematosus (5), renal disease (3), perinatal distress (2), congenital heart disease (1), cerebral A-V malformation (1), and neurosurgery for epilepsy (1). Ten received standard heparin, and 12 received low-molecular-weight heparin (LMWH). One case of silent intracranial bleeding occurred with standard heparin and none with LMWH. A randomized controlled trial was considered warranted. [1]

COMMENT. The use of anticoagulant therapy, in particular low molecular weight heparin, in children with sinovenous thrombosis does not cause bleeding and may improve survival. Presentation of SVT varies with age: infants and young children present with seizures, older children with headache and vomiting.

Prothrombotic disorders and cerebral thromboembolism. Prothrombotic conditions were investigated in 92 children presenting with arterial ischemic stroke (78%) or sinovenous thrombosis (22%) at the Hospital for Sick Children, Toronto. A significant proportion (38%) of children with cerebral thromboembolism had prothrombotic conditions, especially anticardiolipin antibody (33%) [2]. Newborns and older infants and children were equally affected. Infants and children with thromboembolism should be tested for prothrombotic disorders.