Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: A safe treatment option?

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• 作者：Thorsten Ropposch ; ^{thorsten.ropposch@klinikumgraz.at} ; ^{thorsten.ropposch@medunigraz.at} ; Ulrike Nemetz ; Eva Maria Braun ; Andreas Lackner ; Christian Walch
• 关键词：Low molecular weight heparin ; Sigmoid sinus thrombosis ; Lateral sinus thrombosis ; Intracranial complication ; Otitis media ; Mastoiditis
• 刊名：International Journal of Pediatric Otorhinolaryngology
• 出版年：2012
• 期刊代码：135_01655876
• 类别：med
• 出版时间：July, 2012
• 卷：76
• 期：7
• 页码：1023-1026
• 文件大小：264 K

摘要

Objective

Septic thrombosis of the sigmoid and lateral sinus is a rare complication of acute otitis media, mastoiditis and cholesteatoma. Hence, the aim of this chat review was to analyze the demographics, presenting symptoms, diagnosis, and therapeutic management of otogenic sigmoid sinus thrombosis. Especially the role of low molecular weight heparin in the therapy of septic intracranial sinus thrombosis in children should be illuminated.

Methods

A retrospective chart review was performed.

Results

Six patients were included in this trial. One patient was treated completely conservatively. All other patients underwent surgical treatment consisting of mastoidectomy (n = 5), additional thrombectomy (n = 3) and ligation of the internal jugular vein (n = 2). All patients received intravenous antibiotics and anticoagulants. Unfractionated heparin was administered for three days after surgery followed by an anticoagulant therapy with low-molecular weight heparin for three months. The activated partial thromboplastin time (aPTT) and the anti-factor-Xa-plasma-levels were monitored during anticoagulation in short term intervals. There were no complications related to the anticoagulant therapy. Recanalization was found in all patients who were treated without thrombectomy or ligation of the internal jugular vein and in the case of complete conservative treatment.

Conclusion

Simple mastoidectomy combined with broad spectrum antibiotics is the therapy of choice. Our results indicate that anticoagulants represent a safe treatment option if they are administered correctly.