From the Guidelines
Cerebral venous sinus thrombosis (CVST) should be managed with anticoagulation therapy.
Anticoagulation Therapy
- The recommended treatment for CVST is anticoagulation with IV heparin or subcutaneous low molecular weight heparin (LMWH), even in the presence of intracranial hemorrhage 1.
- The goal of anticoagulation is to prevent thrombus propagation and increase recanalization, thereby reducing the risk of worsening neurologic outcomes and pulmonary embolism 1.
Duration of Anticoagulation
- The duration of anticoagulation therapy for CVST is not well defined, but treatment phases of 3 to 12 months have been undertaken in studies 1.
- Extended-phase anticoagulation may be considered in the absence of hormonal or other provocation or in the presence of persisting risk factors for recurrent VTE 1.
Other Considerations
- Patients with CVST should be evaluated for possible causative infections and underlying risk factors for thrombosis 1.
- Endovascular therapy, such as thrombectomy or local intrathrombus infusion of a thrombolytic agent, may be considered in patients with progressive neurologic deterioration despite adequate anticoagulation 1.
- Decompressive hemicraniectomy may be considered in patients with severe mass effect or intracranial hemorrhage 1.
From the Research
Management of Cerebral Venous Sinus Thrombosis (CVST)
The management of CVST involves several strategies, including:
- Anticoagulation with heparin as the mainstay of treatment 2, 3, 4
- Endovascular treatment, such as catheter-based local chemical thrombolysis, balloon angioplasty, and mechanical thrombectomy, for selected patients who are non-responsive to anticoagulants 2, 5, 3
- Identification and elimination of the underlying cause of CVST 6
- Proper management of intracranial hypertension and anticonvulsant prophylaxis 6
- Newer treatment strategies, such as decompressive craniectomy, which have been used with variable success rates 6
Treatment Outcomes
The outcomes of CVST treatment have been reported in several studies, including:
- A 5-year consecutive single-institution cohort study, which found that the majority of patients (92.9%) had a favorable clinical outcome, defined as a modified Rankin score (mRS) ≤2 4
- A review of therapeutic strategies for the management of CVST, which found that existing data support the use of systemic anticoagulation as an initial therapy in all patients, even in the presence of intracranial hemorrhage 3
- A case report and review of the literature, which found that endovascular treatment can be effective in treating CVST, but may also cause complications such as intracranial hemorrhage and vessel dissection 5
Factors Affecting Outcome
Several factors have been reported to affect the outcome of CVST treatment, including: