title: Low molecular weight heparin therapy in pediatric otogenic sigmoid sinus thrombosis: a safe treatment option?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: ENT University Hospital Graz, Medical University Graz, Austria. thorsten.ropposch@klinikumgraz.at
authors.forename: Thorsten
authors.initials: T
authors.lastname: Ropposch
authors.forename: Ulrike
authors.initials: U
authors.lastname: Nemetz
authors.forename: Eva Maria
authors.initials: EM
authors.lastname: Braun
authors.forename: Andreas
authors.initials: A
authors.lastname: Lackner
authors.forename: Christian
authors.initials: C
authors.lastname: Walch
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D007601:Jugular Veins / Q000601:surgery; D008297:Male; D008416:Mastoid / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D017131:Thrombectomy
chemical_list: D000900:Anti-Bacterial Agents; D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight