ABSTRACT
Background : Cerebral venous sinus thrombosis (CVST) is rare in children. Its risk factors and outcome are largely unknown in low-middle income countries. Some case reports have shown presence of anemia in pediatric CVST as a probable risk factor. Aims : This study was done to determine the frequency of anemia in patients having pediatric CVST and to observe its association with the severity of disease. Methods : Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were identified through international classification of diseases (ICD 9). Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Results : Of 143492 patients who were admitted, 32 (21 males and 11 females) with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 2.2 CVST events /10,000 pediatric admissions. Overall mortality was 3.4%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Significant laboratory findings were anemia (65%), low protein S (19%), low protein C (19%), low antithrombin III (6%) and activated protein C resistance (25%). Mean(±SD) hemoglobin in anemic patients was 9.0 g/dL (±2.3). SARS-COV2 was negative in patients tested in 2020. Regression analysis showed a positive association of anemia with multiple sinus involvement ( P 0.009) but anemia had no association with the duration of symptoms ( P 0.344), hospital stay ( P 0.466), age ( P 0.863) or gender ( P 0.542) of the patients. Conclusions : Low hemoglobin was observed in a significant proportion of patients with pediatric CVST. Anemia may be an important biomarker along with other clinical variables in the risk assessment of sinus thrombosis in children. Future studies may unveil the role of anemia in coagulopathy and more specifically in pediatric CVST.
ABSTRACT
Background : Coagulopathy is a recognized feature of severe COVID-19. While high d-dimers are associated with the disease severity and poor outcome, its role in venous thromboembolism (VTE) is evolving. Aims : This study was done to evaluate the d-dimer levels in patients having COVID-19 with and without venous thromboembolic events. Methods : Patients admitted with COVID-19 during March to December 2020 were identified through ICD10 and data was collected through in-house computerized system. Frequency of myocardial infarction (MI), stroke, deep venous thrombosis (DVT), pulmonary embolism (PE) and cerebral venous sinus thrombosis (CVST) was determined. D-dimer was assayed on CS2500 (Sysmex, Kobe, Japan) and was compared in patients with and without DVT/ PE during their hospital stay using non-parametric methods (SPSS version 19). Results : The thromboembolic events included stroke ( n = 41), MI (169), DVT ( n = 4), PE ( n = 21) and CVST ( n = 3) in a total of 2454 patients. Patients having COVID-19 (76 in ICU and 25 with VTE) including 22 females and 79 males with a median (IQR) of 59 years (49.5-65.5) were evaluated for d-dimer levels. There was no statistically significant difference in median (IQR) d-dimers (mg/L) in patients with and without VTE at the time of presentation [1.5 (0.6-3.2) vs. 1.6 (0.7-5.9);P 0.943] and at the last follow-up [2.4 (1.0-4.6) vs. 3.3 (1.3-7.1);P 0.345]. However, there were significantly higher median (IQR) d-dimers of 8.1 (2.7-15.2) in patients having VTE events during hospital stay compared to those who did not have any VTE [3.4 (1.4-10.9), P 0.047]. Moreover, significantly higher median (IQR) d-dimers (mg/L) i.e. 5.0 (2.5-12.0) was observed at the last follow-up in the patients who expired ( n = 48) compared to those ( n = 53) who were discharged alive from the hospital [1.7 (0.7-3.7);P 0.022]. Conclusions : Patients with COVID-19 having VTE had higher level of d-dimers during hospital stay compared to ICU-patients admitted with severe disease.