January 11, 2016: Cerebral venous sinus thrombosis with hemorrhage: Anticoagulation or not?
January 11, 2016
Cerebral venous sinus thrombosis with hemorrhage: Anticoagulation or not?
Intracerebral hemorrhage (ICH) is present in 25 - 75% of patients with cerebral venous sinus thrombosis (CVST) at time of diagnosis. The presence of ICH often causes hesitation in starting anticoagulation. A meta-analysis, comparing heparin to placebo for CVST treatment, contained 40 heparin-treated patients, 18 of whom had ICH at diagnosis. None of the anticoagulated patients developed new ICH (95% confidence interval, incidence of 0 - 9%).1 While there is a small risk of symptomatic ICH with anticoagulation, preventing further clot propagation and venous infarction generally outweighs this risk.
- Coutinho JM, de Bruijn SF, deVeber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database of Systematic Reviews 2011; 8: 1-21.
Submitted by David N. Soleimani-Meigooni, MD, Department of Neurology, Washington University School of Medicine.
Disclosures: Dr. Soleimani-Meigooni reports no disclosures.