Cerebral sinus venous thrombosis during childhood acute lymphoblastic leukemia therapy: Risk factors and management

Abstract

CSVT is an important complication of childhood ALL therapy. Postinduction combined asparaginase and dexamethasone intensive treatment for intermediate-/high-risk patients was the most important risk factor. Treatment with LMWH for a minimum of 3 months, and until asparginase therapy is over, with major radiological improvement seems to be effective and feasible.

Venous thromboembolism in a large cohort of children with acute lymphoblastic leukemia: Risk factors and effect on prognosis

“…However, specific risk factors and mechanisms explaining the predisposition for CVST during ALL treatment are still unclear 10,37 . One risk factor might be the simultaneous administration of steroids as combination therapy (asparaginase and steroids) occurred twice as much in patients with CSVT than in patients with other VTE 11 …”

“…The overall mortality rate in ALL patients as a result of VTE varies between 0% and 4.8% . A substantial proportion of VTE in ALL is due to cerebral venous sinus thrombosis (CVST) with a reported mortality between 0% and 28% . Morbidity includes recurrent thrombosis, neurologic changes, catheter removal, bleeding due to antithrombotic agents, and the development of the postthrombotic syndrome .…”

“…6 A substantial proportion of VTE in ALL is due to cerebral venous sinus thrombosis (CVST) with a reported mortality between 0% and 28%. [8][9][10][11] Morbidity includes recurrent thrombosis, neurologic changes, catheter removal, bleeding due to antithrombotic agents, and the development of the postthrombotic syndrome. [12][13][14]15 Furthermore, VTE can lead to suboptimal ALL therapy, due to the necessity to interrupt, delay, or even discontinue chemotherapy, and thereby to inferior disease outcomes.…”

Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association

“…347 Some chronic systemic and inflammatory conditions are associated with CSVT, including inflammatory bowel disease 334,336,348 ; Behçet syndrome; systemic lupus erythematosus 336,337,343,349 (related to lupus anticoagulant and antiphospholipid antibodies); homocystinuria 337,344 ; protein-losing conditions such enteropathy, nephropathy, 336,339,342,350 and liver failure that lead to a hypercoagulable state; congenital heart disease 47,49,333 (related to decreased venous return and instrumentation); and thyrotoxicosis. 351,352 Childhood malignancy, particularly acute lymphoblastic leukemia 353,354 and central nervous system tumors, 332,339,342,343 may be associated with CSVT as a result of a chemotherapy-related hypercoagulable state (L-asparaginase), antithrombin deficiency, or mass effect with venous compression or invasion. Prothrombotic drugs such as steroids 334 and estrogen-containing contraceptives have also been linked to CSVT.…”

Suspected adverse reaction to compounded preparations prescribed for weight loss: two cases of cerebral venous thrombosis

“…CVT is three times more frequent in women than in men and several risk factors for CVT have been identified: some are general risk factors for venous thromboembolism (VTE) such as hereditary thrombophilia, use of oral contraceptives, cancer, pregnancy and puerperium, and others are specific risk factors to CVT, such as head injury, dural arteriovenous fistula, head and neck infections, spontaneous intracranial hypotension and dehydration 1 4–7. Very well-established pharmacological risk factors for CVT are oral contraception and hormone replacement therapy4 8; conversely CVT has sporadically been reported as adverse drug reaction (ADR) with other drugs such as anabolic androgenic steroids, corticosteroids, erythropoietin, sildenafil, l-asparaginase and dexamethasone among others 9–15. Within illicit drugs, CVT has been reported to be related to cocaine use 16…”