From the Guidelines
Sinus venous thrombosis is most strongly associated with risk factors such as pregnancy, use of oral contraceptives, hypercoagulable states, malignancy, and infections, as identified in the most recent and highest quality study 1.
Risk Factors for Sinus Venous Thrombosis
The risk factors for sinus venous thrombosis can be divided into acquired and genetic risks. Acquired risks include:
- Pregnancy and the postpartum period
- Use of oral contraceptives, especially those containing estrogen
- Malignancy
- Infections, particularly of the ear, sinus, mouth, face, or meninges
- Dehydration
- Inflammatory bowel disease
- Connective tissue disorders like lupus
- Local trauma to the head or neck
- Neurosurgical procedures
- Lumbar punctures
- Certain medications, such as tamoxifen and certain chemotherapeutic agents
Genetic risks include:
- Hypercoagulable states, such as Factor V Leiden mutation, protein C or S deficiency, and antithrombin III deficiency
- Inherited thrombophilia
Importance of Identifying Risk Factors
Identifying these risk factors is crucial for both prevention in high-risk individuals and prompt diagnosis in those presenting with suspicious neurological symptoms. The underlying mechanism involves blood clot formation in the venous sinuses that drain blood from the brain, leading to increased intracranial pressure and potentially causing stroke-like symptoms, seizures, and headaches. The most recent study 1 highlights the importance of considering multiple risk factors, including age, central venous access devices, surgical history, and congenital thrombophilia, in the assessment of pediatric patients. The presence of multiple risk factors simultaneously heightens the risk of sinus venous thrombosis, emphasizing the need for careful evaluation and management of high-risk individuals 1.
From the Research
Sinus Venous Thrombosis Risk Factors
The risk factors for sinus venous thrombosis can be divided into several categories, including:
- Acquired risk factors, such as:
- Hormonal changes (e.g. oral contraceptives use, hormone replacement therapy, pregnancy and puerperium) 2
- Mechanical precipitants (e.g. head trauma, jugular catheterization, surgery, lumbar puncture) 2
- Local and generalized infections 2
- Cancer 2
- Acquired prothrombotic states (e.g. hyperhomocysteinemia, nephrotic syndrome) 2
- Inflammatory diseases (e.g. vaculitis, intestinal inflammatory disease) 2
- Hematological disorders 2
- Neurological diseases (e.g. dural arteriovenous malformations, spontaneous intracranial hypotension) 2
- Drugs and other situations 2
- Genetic risk factors, such as:
- Other risk factors, including:
- Autoimmune diseases, such as Behcet's syndrome and other autoimmune diseases 4
- Dehydration 5
- Intracranial tumors 5
- Coagulopathies 5
- Fibrous thyroiditis 5
- Jugular thrombosis after catheterization or idiopathic jugular vein stenosis 5
- Surgery 5
- Head trauma 5
- Arterio-venous malformations 5
- Paraneoplastic and autoimmune disease 5
Specific Risk Factors
Some specific risk factors have been identified, including:
- Oral contraceptives use, which can increase the risk of sinus venous thrombosis 2, 5
- Pregnancy and puerperium, which can also increase the risk of sinus venous thrombosis 2, 5
- Cancer, which can increase the risk of sinus venous thrombosis 2, 5
- Autoimmune diseases, such as Behcet's syndrome, which can increase the risk of sinus venous thrombosis 4
- Dehydration, which can increase the risk of sinus venous thrombosis 5
Multifactorial Disease
Sinus venous thrombosis is a multifactorial disease, and the risk factors can have additive effects 2. The separation of genetic and acquired risk factors is somewhat artificial, as they can interact with each other 2. Further studies are needed to better understand the pathogenesis of sinus venous thrombosis and to develop preventive, diagnostic, and therapeutic strategies 2, 6.