January 11, 2016: Cerebral venous sinus thrombosis with hemorrhage: Anticoagulation or not?

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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.

  1. 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.

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