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Systemic thrombolysis for cerebral venous and dural sinus thrombosis: a systematic review

L D Viegas1, E Stolz, P Canhão

  • 1Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.

Cerebrovascular Diseases (Basel, Switzerland)
|December 21, 2013
PubMed

Insights

Systemic thrombolysis for cerebral venous thrombosis (CVT) showed an 88% independence rate but carried bleeding risks. Efficacy remains unproven due to limited data, though outcomes mirror previous reviews.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Interventional Neurology

Background:

  • Cerebral venous and dural sinus thrombosis (CVT) management often considers thrombolytics for patients worsening on anticoagulation.
  • Assessing the role of systemic thrombolysis in improving outcomes for CVT is crucial.

Purpose of the Study:

  • To systematically review and analyze published data on systemic thrombolysis use in CVT.
  • To evaluate the efficacy and safety profile of thrombolytic therapy in CVT patients.

Main Methods:

  • A comprehensive PubMed search and reference list review were conducted.
  • Data from the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) were incorporated.
  • Patient outcomes were assessed using the modified Rankin Scale (mRS) at last follow-up.

Main Results:

  • 16 reports involving 26 CVT patients were analyzed; no randomized trials were found.
  • Urokinase was the most common agent; intracranial hemorrhage occurred in 11.5% and serious bleeding in 11.5% (2 deaths).
  • 88% of patients achieved independence (mRS 0-2), with a survival rate of 92.3%.

Conclusions:

  • Systemic thrombolysis in CVT resulted in high functional independence but was associated with significant bleeding risks.
  • The efficacy of systemic thrombolysis for acute CVT remains uncertain due to small sample sizes and lack of control groups.
  • Bleeding complications necessitate careful consideration of the risks versus benefits in clinical practice.
Abstract

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