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Peer-reviewedCC BYResearch and Practice in Thrombosis and Haemostasis

Efficacy and safety of anticoagulation for pediatric cerebral sinovenous thrombosis: systematic review and meta-analysis

  • Muayad Azzam1
  • Hassan Kawtharany2
  • Marisol Betensky3
  • Aseel Alkhader1
  • Qais Hamarsha1
  • Hadi Khaled Abou Zeid4
  • Razan Mansour5
  • Carine Tabak6
  • Payal Patel7
  • Sarah Lamat Baghdadi6
  • Rachel S. Bercovitz8
  • Rukhmi Bhat8
27 more authors
  • Tina Biss9
  • Brian R. Branchford10
  • Leonardo R. Brandão11
  • Anthony K.C. Chan12
  • E. Vincent S. Faustino13
  • Julie Jaffray14
  • Sophie Jones15
  • Bryce A. Kerlin16
  • Nicole Kucine17
  • Riten Kumar18
  • Christoph Male19
  • Marie-Claude Pelland-Marcotte20
  • Leslie Raffini21
  • Chittalsinh M. Raulji22
  • Sarah E. Sartain23
  • Clifford M. Takemoto24
  • Cristina Tarango25
  • C. Heleen Van Ommen26
  • Maria C. Velez27
  • Sara K. Vesely28
  • John Wiernikowski29
  • Suzan Williams11
  • Hope P. Wilson30
  • Gary Woods31
  • Ayesha Zia32
  • Paul Monagle33
  • Reem A. Mustafa34
34 affiliations
  1. 1Evidence-Based Practice and Impact Center, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
  2. 2Evidence-Based Practice and Impact Center, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA; Department of Internal Medicine, Saint Louis University School of Medicine, St louis, MO, USA
  3. 3Department of Pediatrics, Division of Hematology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA
  4. 4Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
  5. 5Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
  6. 6University of Kansas School of Medicine, Kansas City, KS, USA
  7. 7Department of Emergency Medicine-Critical Care Medicine, Emory University, Atlanta, GA, USA
  8. 8Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
  9. 9Department of Haematology, The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, Tyne & Wear, United Kingdom
  10. 10Department of Hematology, Versiti Medical Sciences Institute, Wauwatosa, WI, USA
  11. 11Division of Hematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
  12. 12Department of Pediatrics, McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
  13. 13Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
  14. 14Department of Pediatrics, Division of Hematology/Oncology, University of California, San Diego, Rady Children’s Hospital, San Diego, CA, USA
  15. 15Department of Nursing, University of Melbourne, Royal Children's Hospital, Melbourne, Australia
  16. 16Department of Pediatrics, Nationwide Children’s Hospital and The Ohio State University College of Medicine, Columbus, OH, USA
  17. 17Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
  18. 18Department of Pediatrics, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
  19. 19Department of Paediatrics, Medical University of Vienna, Vienna, Austria
  20. 20Division of Hematology-Oncology, Department of Pediatrics, CHU de Québec, Centre Mère-Enfant Soleil, Québec, QC, Canada
  21. 21Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
  22. 22Department of Pediatric Hematology Oncology, University of Nebraska Medical Center, Omaha, NE
  23. 23Department of Pediatrics, Section of Hematology, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
  24. 24Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN, USA
  25. 25Department of Pediatrics, University of Cincinnati College of Medicine, Cancer and Blood Disease Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
  26. 26Department of Pediatric Hematology, Erasmus Medical Center Sophia Children's Hospital, Rotterdam, Netherlands
  27. 27Department of Pediatrics, Division of Hematology-Oncology, Louisiana State University Health Sciences Center and Manning Family Children’s, New Orleans, LA, USA
  28. 28Hudson College of Public Health, Department of Biostatistics and Epidemiology, University of Oklahoma Health, Oklahoma City, OK, USA
  29. 29Department of Pediatrics, Division of Hematology/Oncology, McMaster University, Hamilton, ON, Canada
  30. 30Department of Pediatrics, University of Alabama at Birmingham Heersink School of Medicine and Children’s of Alabama, Birmingham, AL, USA
  31. 31Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
  32. 32Department of Pediatrics, Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX, USA
  33. 33Departments of Paediatrics and Haematology, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Victoria, Australia
  34. 34Division of Nephrology and Hypertension, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
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Abstract

We performed this systematic review and meta-analysis to assess the efficacy and safety of anticoagulation therapy versus no anticoagulation in pediatric patients with cerebral sinovenous thrombosis (CSVT). Eligible studies included pediatric patients with CSVT that compared anticoagulation to no anticoagulation and reported on at least one relevant outcome (mortality, neurological deficit, thrombus resolution, recurrence, and bleeding). Meta-analysis reported risk ratios (RR) or differences (RD) (95% CIs) and absolute effects per 1000 patients. Risk of bias was assessed using ROBINS-I, and the certainty of evidence was evaluated with GRADE. After removing duplicates, we screened 8925 records independently and in duplicate, from which 12 nonrandomized studies of intervention were included. Compared with no anticoagulation, anticoagulation may be associated with lower risk of overall mortality RR 0.14 (0.05-0.39) (4 studies, n = 448), lower risk of neurological deficits RD −0.13 (−0.39 to 0.13) (6 studies, n = 462), and higher rates of complete and partial resolution RR 1.25 (0.94-1.66) (7 studies, n = 150). Recurrence RD 0 (−0.11 to 0.11) (2 studies, n = 56) and bleeding RD 0.03 (−0.09 to 0.15) (5 studies, n = 95) may be comparable between anticoagulation versus no anticoagulation. We judged outcomes to be very low to low certainty of evidence due to risk of bias, concerns from confounding, and imprecision from small sample sizes. To conclude, we show in this systematic review that anticoagulation therapy in pediatric patients with CSVT may be associated with better outcomes (reduced mortality, neurological deficits, and higher rate of thrombus resolution) with little to no effect on bleeding and recurrence.

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Cite

BibTeXRIS
BibTeX
@article{azzam2026efficacy,
  title = {{Efficacy and safety of anticoagulation for pediatric cerebral sinovenous thrombosis: systematic review and meta-analysis}},
  author = {Muayad Azzam and Hassan Kawtharany and Marisol Betensky and Aseel Alkhader and Qais Hamarsha and Hadi Khaled Abou Zeid and Razan Mansour and Carine Tabak and Payal Patel and Sarah Lamat Baghdadi and Rachel S. Bercovitz and Rukhmi Bhat and Tina Biss and Brian R. Branchford and Leonardo R. Brandão and Anthony K.C. Chan and E. Vincent S. Faustino and Julie Jaffray and Sophie Jones and Bryce A. Kerlin and Nicole Kucine and Riten Kumar and Christoph Male and Marie-Claude Pelland-Marcotte and Leslie Raffini and Chittalsinh M. Raulji and Sarah E. Sartain and Clifford M. Takemoto and Cristina Tarango and C. Heleen Van Ommen and Maria C. Velez and Sara K. Vesely and John Wiernikowski and Suzan Williams and Hope P. Wilson and Gary Woods and Ayesha Zia and Paul Monagle and Reem A. Mustafa},
  journal = {Research and Practice in Thrombosis and Haemostasis},
  year = {2026},
  month = aug,
  doi = {10.1016/j.rpth.2026.106905},
  url = {https://doi.org/10.1016/j.rpth.2026.106905},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Efficacy and safety of anticoagulation for pediatric cerebral sinovenous thrombosis: systematic review and meta-analysis
AU  - Muayad Azzam
AU  - Hassan Kawtharany
AU  - Marisol Betensky
AU  - Aseel Alkhader
AU  - Qais Hamarsha
AU  - Hadi Khaled Abou Zeid
AU  - Razan Mansour
AU  - Carine Tabak
AU  - Payal Patel
AU  - Sarah Lamat Baghdadi
AU  - Rachel S. Bercovitz
AU  - Rukhmi Bhat
AU  - Tina Biss
AU  - Brian R. Branchford
AU  - Leonardo R. Brandão
AU  - Anthony K.C. Chan
AU  - E. Vincent S. Faustino
AU  - Julie Jaffray
AU  - Sophie Jones
AU  - Bryce A. Kerlin
AU  - Nicole Kucine
AU  - Riten Kumar
AU  - Christoph Male
AU  - Marie-Claude Pelland-Marcotte
AU  - Leslie Raffini
AU  - Chittalsinh M. Raulji
AU  - Sarah E. Sartain
AU  - Clifford M. Takemoto
AU  - Cristina Tarango
AU  - C. Heleen Van Ommen
AU  - Maria C. Velez
AU  - Sara K. Vesely
AU  - John Wiernikowski
AU  - Suzan Williams
AU  - Hope P. Wilson
AU  - Gary Woods
AU  - Ayesha Zia
AU  - Paul Monagle
AU  - Reem A. Mustafa
PY  - 2026
DA  - 2026/08/01
JO  - Research and Practice in Thrombosis and Haemostasis
DO  - 10.1016/j.rpth.2026.106905
UR  - https://doi.org/10.1016/j.rpth.2026.106905
AB  - We performed this systematic review and meta-analysis to assess the efficacy and safety of anticoagulation therapy versus no anticoagulation in pediatric patients with cerebral sinovenous thrombosis (CSVT). Eligible studies included pediatric patients with CSVT that compared anticoagulation to no anticoagulation and reported on at least one relevant outcome (mortality, neurological deficit, thrombus resolution, recurrence, and bleeding). Meta-analysis reported risk ratios (RR) or differences (RD) (95% CIs) and absolute effects per 1000 patients. Risk of bias was assessed using ROBINS-I, and the certainty of evidence was evaluated with GRADE. After removing duplicates, we screened 8925 records independently and in duplicate, from which 12 nonrandomized studies of intervention were included. Compared with no anticoagulation, anticoagulation may be associated with lower risk of overall mortality RR 0.14 (0.05-0.39) (4 studies, n = 448), lower risk of neurological deficits RD −0.13 (−0.39 to 0.13) (6 studies, n = 462), and higher rates of complete and partial resolution RR 1.25 (0.94-1.66) (7 studies, n = 150). Recurrence RD 0 (−0.11 to 0.11) (2 studies, n = 56) and bleeding RD 0.03 (−0.09 to 0.15) (5 studies, n = 95) may be comparable between anticoagulation versus no anticoagulation. We judged outcomes to be very low to low certainty of evidence due to risk of bias, concerns from confounding, and imprecision from small sample sizes. To conclude, we show in this systematic review that anticoagulation therapy in pediatric patients with CSVT may be associated with better outcomes (reduced mortality, neurological deficits, and higher rate of thrombus resolution) with little to no effect on bleeding and recurrence.
SN  - 2475-0379
ER  -