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Critical care management of cerebral venous thrombosis

David Fam1, Gustavo Saposnik,

  • 1aDepartment of Neurology, University of Toronto School of Medicine bStroke Outcomes Research Unit, Li Ka Shing Knowledge Institute cInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada *Website: http://www.sorcan.ca.

Current Opinion in Critical Care
|December 10, 2015
PubMed

Insights

Systemic anticoagulation is the primary treatment for cerebral venous thrombosis (CVT), even with bleeding. Endovascular therapy may benefit select CVT patients with worsening symptoms despite anticoagulation.

Area of Science:

  • Neurology
  • Vascular Medicine

Background:

  • Cerebral venous thrombosis (CVT) management is less understood than ischemic stroke.
  • Evidence for interventions in CVT is limited.

Purpose of the Study:

  • To review current evidence on CVT management.
  • To summarize data on anticoagulation and endovascular therapy for CVT.

Main Methods:

  • Literature review of existing studies on CVT treatment.
  • Analysis of data on anticoagulation efficacy and safety.
  • Evaluation of endovascular therapy outcomes in CVT.

Main Results:

  • Systemic anticoagulation is the standard treatment for CVT, including cases with intracerebral hemorrhage.
  • Endovascular therapy appears safe in CVT and may improve outcomes for patients with neurological decline despite anticoagulation.

Conclusions:

  • While most CVT patients have a good prognosis, 25% experience acute neurological deterioration.
  • Risk factors for deterioration include neurological deficits, seizures, deep venous thrombosis, venous infarction, and intracranial hemorrhage.
  • Further randomized trials are necessary to compare anticoagulation and endovascular therapy for CVT.
Abstract

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