Safety and outcome of anticoagulant therapy in neonates and children with cerebral sinovenous thrombosis (CSVT) were determined in a study at the Hospital for Sick Children and Toronto Western Hospital, Ontario, Canada. Neonates presented with seizures and encephalopathy, children had headache and raised intracranial pressure. Prothrombotic abnormalities occurred in 76%. Among 162 pediatric patients, 85 received anticogulants (standard/low molecular weight heparin, warfarin), including 29/83 (35%) neonates and 56/79 (71%) children. Mean interval from diagnosis to anticoagulant initiation was 4 days. Major hemorrhage occurred in 6% (6/99) of treated patients; they were all nonfatal and clinical outcome was favorable in 50%. Follow-up imaging showed thrombus propagation in 11/57 neonates (10/35 [28%] without and 1/22 [4%] with anticoagulant therapy (p=0.037)) and in 10/63 children (7/19 [37%] without and 3/44 [7%] with anticoagulant [p=0.006]). Propagation was associated with new venous infarcts in 10% neonates and 40% children and worse clinical outcome in children (p=0.053). Recanalization occurred earlier and more completely in neonates (p=0.002). Clinical outcome was unfavorable in 47%. 
COMMENT. In this large single-center cohort study of anticoagulant safety in pediatric CSVT, treatment-related hemorrhage was infrequent whereas in untreated patients, thrombus propagation was frequent, occurring in one-third patients. The authors conclude that anticoagulants deserve strong consideration in pediatric CSVT.