Efficacy and safety of anticoagulation for pediatric cerebral sinovenous thrombosis: systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
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, bleeding). Meta-analysis reported risk ratios (RR) or differences (RD) (95% confidence intervals), and absolute effects per 1,000 patients. Risk of bias was assessed using ROBINS-I, and the certainty of evidence (COE) was evaluated with GRADE. After removing duplicates, we screened 8,925 records independently and in duplicate, from which 12 non-randomized studies of intervention were included. Compared to no anticoagulation, anticoagulation may be associated with lower risk of overall mortality risk ratio (RR) 0.14 (0.05 – 0.39) (4 studies, n=448), lower risk of neurological deficits risk difference (RD) -0.13 (-0.39 – 0.13) (6 studies, n=462), and higher rates of complete and partial resolution RR 1.25 (0.94 to 1.66) (7 studies, n=150). Recurrence RD 0 (-0.11 – 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 COE 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.
Authors: Muayad Azzam, Hassan Kawtharany, Marisol Betensky, Aseel Alkhader, Qais Hamarsha, Hadi Khaled Abou Zeid, Razan Mansour, Carine Tabak, Payal Patel, Sarah Lamat Baghdadi, Rachel S. Bercovitz, Rukhmi Bhat, Tina Biss, Brian R. Branchford, Leonardo R. Brandão, Anthony K.C. Chan, E. Vincent S. Faustino, Julie Jaffray, Sophie Jones, Bryce A. Kerlin, Nicole Kucine, Riten Kumar, Christoph Male, Marie-Claude Pelland-Marcotte, Leslie Raffini, Chittalsinh M. Raulji, Sarah E. Sartain, Clifford M. Takemoto, Cristina Tarango, C. Heleen Van Ommen, Maria C. Velez, Sara K. Vesely, John Wiernikowski, Suzan Williams, Hope P. Wilson, Gary Woods, Ayesha Zia, Paul Monagle, Reem A. Mustafa
Institutions: University of Kansas Medical Center, Saint Louis University, Johns Hopkins University, Johns Hopkins All Children's Hospital, Mayo Clinic, University of Kansas, Emory University, Northwestern University, Lurie Children's Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne Hospital, University of Toronto, Hospital for Sick Children, McMaster Children's Hospital, McMaster University, Yale University, University of California San Diego, Rady Children's Hospital-San Diego, Royal Children's Hospital, The University of Melbourne, Nationwide Children's Hospital, The Ohio State University, Weill Cornell Medicine, Harvard University, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Medical University of Vienna, Centre hospitalier universitaire de Québec, University of Pennsylvania, University of Nebraska Medical Center, Baylor College of Medicine, Texas Children's Hospital, St. Jude Children's Research Hospital, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Erasmus MC, Erasmus MC - Sophia Children’s Hospital, Louisiana State University, Louisiana State University Health Sciences Center New Orleans, University of Oklahoma, Children's of Alabama, University of Alabama at Birmingham, UAB Medicine, Children's Healthcare of Atlanta, The University of Texas Southwestern Medical Center, Murdoch Children's Research Institute
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,250
OpenAlex ID: W7203483057