Skip to main content Skip to main navigation menu Skip to site footer

Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method


Introduction. The incidence rate of Cerebral Venous Thrombosis (CVT) in children has been increased quite significantly due to the availability of advanced imaging technology and the trends of increasing awareness about health-related problem. Systemic anticoagulant was mainstay treatment for CVT. The author proposed a method of heparin deliveries through existing Digital Subtraction Angiography (DSA) procedure called Intra-arterial Heparin Flushing (IAHF). The safety of this procedure in children was still few known and reported. The purpose of this study is to provide insights on CVT and the potential complication of IAHF as the primary therapeutic modality.

Methods. This was a descriptive longitudinal study involving all patients with age 0-18 years diagnosed with Cerebral Venous Thrombosis whom admitted in RSPAD Gatot Soebroto from 2016 to 2018 through MRI examination and will undergo IAHF Procedure as the primary treatment. All subject had signed informed consent regarding the nature of the study. The descriptive data were presented in tables and narratives.

Results. The study found that the highest age group found in this study was between 6-12 years old (46,6%) with male-predominant (70,6%). The origins of the patients were mostly from Indonesia (88%) and several from Vietnam (12%). The most common symptoms of CVT in this study was the speech/communication problem (12%). The most common complication after IAHF procedure was wound swelling at the puncture site (2,6%).

Conclusion. CVT predominantly affect male aged 6-12 years old with speech problem was the most common symptoms. IAHF procedure shown minimal side effects in pediatric with CVT.


  1. Hashmi M., Wasay M. Caring for cerebral venous sinus thrombosis in children. J Emerg Trauma Shock. 4(3):389–94.
  2. Wiryadana K.A., Supadmanaba I.G.P., Samatra D.P.G.P. Progress and potential roles blood biomarkers of ischemic stroke in clinical setting. Indones J Biomed Sci. 2017;11(2):19.
  3. Ichord R. Cerebral Sinovenous Thrombosis. Front Pediatr. 2017;5:163.
  4. DeVeber G., Andrew M., Adams C., Bjornson B., Booth F., Buckley D.J., et al. Cerebral Sinovenous Thrombosis in Children. N Engl J Med. 2001;345:417–23.
  5. Dlamini N., Billinghurst L., Kirkham F.J. Cerebral venous sinus (sinovenous) thrombosis in children. Neurosurg Clin N Am. 2010;21(3):511–27.
  6. Sébire G., Tabarki B., Saunders D.E., Leroy I., Liesner R., Saint-Martin C., et al. Cerebral venous sinus thrombosis in children: risk factors, presentation, diagnosis and outcome. Brain a J Neurol. 2005;128(3):477–89.
  7. Carvalho K.S., Bodensteiner J.B., Connolly P.J., Garg B.P. Cerebral venous thrombosis in children. J Child Neurol. 16(8):574–80.
  8. Wasay M., Dai A.I., Ansari M., Shaikh Z., Roach E.S. Cerebral venous sinus thrombosis in children: a multicenter cohort from the United States. J Child Neurol. 2008;23(1):26–31.
  9. Ferro J.M., Canhão P., Stam J., Bousser M.-G., Barinagarrementeria F., ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke. 2004;35(3):664–70.
  10. Valdueza J.M., von Münster T., Hoffman O., Schreiber S., Einhäupl K.M. Postural dependency of the cerebral venous outflow. Lancet. 2000;355:200–1.
  11. Sajjad Z. MRI and MRV in cerebral venous thrombosis. J Pak Med Assoc. 56(11):523–6.
  12. Teksam M., Moharir M., Deveber G., Shroff M. Frequency and topographic distribution of brain lesions in pediatric cerebral venous thrombosis. Am J Neuroradiol. 2008;29(10):1961–5.
  13. Roach E.S., Golomb M.R., Adams R., Biller J., Daniels S., Deveber G., et al. Management of stroke in infants and children: a scientific statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young. Stroke. 2008;39(9):2644–91.
  14. Griesmer D.A., Theodorou A.A., Berg R.A., Spera T.D. Local fibrinolysis in cerebral venous thrombosis. Pediatr Neurol. 1994;10:78–80.
  15. Soleau S.W., Schmidt R., Stevens S., Osborn A., MacDonald J.D. Extensive experience with dural sinus thrombosis. Neurosurgery. 1994;52(3):534–44.
  16. Yoon N.K., McNally S., Taussky P., Park M.S. Imaging of cerebral aneurysms: a clinical perspective. Neurovascular Imaging. 2016;2(1):6.
  17. Putranto T., Yusuf I., Murtala B., Wijaya A. Intra Arterial Heparin Flushing Increases Manual Muscle Test-Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient. Bali Med J. 2016;5(2):216–20.
  18. Burger I.M., Murphy K.J., Jordan L.C., Tamargo R.J., Gailloud P. Safety of cerebral digital subtraction angiography in children: complication rate analysis in 241 consecutive diagnostic angiograms. Stroke. 2006;37(10):2535–9.
  19. Johnson M.C., Parkerson N., Ward S., de Alarcon P.A. Pediatric sinovenous thrombosis. J Pediatr Hematol Oncol. 2003;25(4):312–5.
  20. Bashir Q., Ishfaq A., Baig A.A. Safety of Diagnostic Cerebral and Spinal Digital Subtraction Angiography in a Developing Country: A Single-Center Experience. Interv Neurol. 2018;7(1–2):99–109.
  21. Kulcsár Z., Marosfoi M., Berentei Z., Szikora I. Continuous thrombolysis and repeated thrombectomy with the Penumbra System in a child with hemorrhagic sinus thrombosis: technical note. Acta Neurochir (Wien). 2010;152(5):911–6.

How to Cite

Pramono, A., Soetikno, R., Kartamihardja, A. H. S., Maskoen, T. T., Putranto, T. A., & Setiawan, E. (2019). Short insight of pediatric cerebral venous thrombosis and the safety of intra-arterial heparin flushing as a new therapeutic method. Bali Medical Journal, 8(2), 560–564.




Search Panel

Ardianto Pramono
Google Scholar
BMJ Journal

Ristaniah Soetikno
Google Scholar
BMJ Journal

Achmad Hussein Sundawa Kartamihardja
Google Scholar
BMJ Journal

Tinni Trihartini Maskoen
Google Scholar
BMJ Journal

Terawan Agus Putranto
Google Scholar
BMJ Journal

Erwin Setiawan
Google Scholar
BMJ Journal