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Thrombolytics for cerebral sinus thrombosis: a systematic review
Patricia Canhão1, Filipa Falcão, José M Ferro
1Neurology Department, Hospital de Santa Maria, Lisbon, Portugal. jferro@mail.telepac.pt
Cerebrovascular Diseases (Basel, Switzerland)
|March 21, 2003
Summary
Thrombolytics may be safe for cerebral venous thrombosis (CVDST) patients, but their effectiveness remains unproven due to limited data. Further research is needed to confirm efficacy and safety in this rare condition.
Area of Science:
- Neurology
- Vascular Medicine
- Thrombosis Research
Background:
- Cerebral venous or dural sinus thrombosis (CVDST) management often involves thrombolytics for patients with deteriorating conditions despite anticoagulation.
- Published data on thrombolytic use in CVDST is limited, necessitating a comprehensive review.
Purpose of the Study:
- To systematically collect and analyze all published information regarding thrombolytic therapy in CVDST.
- To evaluate the efficacy and safety profile of thrombolytics in patients with CVDST.
Main Methods:
- A comprehensive MEDLINE search (1966-2001) and manual searches of relevant journals were conducted.
- Data extraction from 72 studies involving 169 patients treated with thrombolytics for CVDST.
- Outcomes and complications were analyzed using proportions and confidence intervals; subgroup analyses were performed.
Main Results:
- No randomized clinical trials were identified; the review included observational studies and case reports.
- Urokinase was the most common thrombolytic (76%), often administered via local infusion (88%).
- Outcomes included dependency in 7% and mortality in 5% of patients. Intracranial hemorrhage occurred in 17% (5% with deterioration), and extracranial hemorrhage in 21% (2% requiring transfusion).
Conclusions:
- Thrombolytics appear to have a reasonable safety profile in CVDST, with manageable bleeding complications.
- The efficacy of thrombolytics in CVDST cannot be definitively assessed from current published data.
- A multicenter, international randomized controlled trial is proposed to evaluate the effectiveness and safety of local thrombolytics in high-risk CVDST cases.