From the Guidelines
Approximately 45% of patients with sinus venous thrombosis experience complete recanalization of the affected channels after anticoagulation treatment. This estimate is based on the most recent and highest quality study available, which reported a complete recanalization rate of 45% in patients with acute sinus venous thrombosis treated with anticoagulation 1. The treatment typically involves low molecular weight heparin followed by oral anticoagulants for 3-12 months. Some key points to consider in the management of sinus venous thrombosis include:
- Anticoagulation therapy is the standard treatment for sinus venous thrombosis, with the goal of preventing further thrombus formation and promoting recanalization 1
- The recanalization rate can vary depending on the specific sinuses involved, with some studies reporting higher rates of complete recanalization in the superior sagittal sinus and transverse sinuses compared to the deep venous system
- Clinical improvement does not always correlate with radiological recanalization, as many patients with partial or no recanalization still achieve good clinical outcomes due to the development of collateral venous drainage 1
- Regular follow-up imaging, typically MR venography or CT venography, is recommended to assess recanalization status and guide treatment decisions 1.
From the Research
Recanalization of Sinus Venous Channels after Anticoagulation Treatment
- The percentage of patients with complete recanalization of the affected channels after anticoagulation treatment varies across studies.
- A study published in 2017 found that complete recanalization was observed in 15 patients (48.4%) out of 31 patients with at least six months follow-up 2.
- Another study published in 2016 reported that complete recanalization (CRec) was achieved in 57.6% (57/99) of patients with cerebral sinus and/or venous thrombosis (CSVT) 3.
- A meta-analysis published in 2022 found that the use of Direct Oral Anticoagulants (DOACs) in CVT has similar efficacy and safety compared to VKAs with better recanalization rate, although the exact percentage of complete recanalization was not specified 4.
- The factors associated with recanalization include gender, with female patients having higher complete recanalization rates 2, and the location of thrombosis, with thrombosis of the superior sagittal sinus being a positive predictor of recanalization 3.
Factors Influencing Recanalization
- The temporal course of recanalization and its association with clinical outcome were analyzed in a study published in 2016, which found that the median time to complete recanalization was 6 months 3.
- A study published in 2002 examined the relationship between recanalization and plasma markers of coagulation and fibrinolysis, and found that percent recanalization was directly associated with initial t-PA activity levels and inversely related to F 1+2, t-PA antigen, and PAI-1 levels 5.
- The prognosis and recanalization rates of CVST were found to be good, with complete or partial recanalization of venous sinuses not being associated with clinical outcome 2, 3.