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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
Insights
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.
Background And Purpose:
The use of thrombolytics is frequently mentioned in patients with cerebral venous or dural sinus thrombosis (CVDST) who deteriorate despite anticoagulant therapy. The aim of this review was to collect all the published information about their use in CVDST and to assess their efficacy and safety.
Methods:
To find cases of CVDST treated with thrombolytics, we performed a MEDLINE search from 1966 to July 2001, checked all reference lists of studies found and hand searched volumes of 11 journals. Data was extracted by means of a standardised data extraction form. Proportions and 95% confidence intervals (CI) were calculated for outcomes and complications of thrombolytics. Cases were stratified according to variables that may influence the outcome and subgroups were compared by odds ratios and 95% CI.
Results:
No randomised clinical trial (RCT) was found. Seventy-two studies (169 patients) were included. Urokinase was the thrombolytic most frequently administered (76%). In the majority of cases the thrombolytic was locally infused in the occluded sinus (88%). At discharge, 10 cases (7%; 95% CI 3-12%) were dependent and 9 cases (5%; 95% CI 2-9%) died. Intracranial haemorrhages occurred in 17% of cases. In 5% they were associated with clinical deterioration. Extracranial haemorrhages occurred in 21%, but only 2% required blood transfusion.
Conclusions:
Thrombolytics appeared to be reasonably safe in CVDST, but its efficacy cannot be assessed from the published data. Considering that CVDST is an uncommon disease, a randomised controlled trial to assess effectiveness and safety of local thrombolytics in cases of CVDST with poor prognosis is difficult but not impossible to undertake, on a multicentre international collaboration trial.
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