Related Experiment Video
Updated: Jun 8, 2025
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Treatment of cerebral venous thrombosis: a review
Hamish Patel1, India Lunn2, Sajid Hameed3
1Department of Neurology, Royal Hallamshire Hospital, Broomhall, UK.
Insights
Cerebral venous thrombosis (CVT) management primarily involves anticoagulation with heparin. COVID-19 related CVT is treated similarly, but vaccine-related CVT requires different approaches including immunotherapy and steroids.
Area of Science:
- Neurology
- Vascular Medicine
- Infectious Diseases
Background:
- Cerebral venous thrombosis (CVT) is an uncommon yet significant cause of stroke.
- Emerging evidence links COVID-19 infection and vaccination to CVT.
- Novel therapeutic strategies including fibrinolysis and mechanical thrombectomy are being explored.
Purpose of the Study:
- To review current evidence on managing CVT, including COVID-19 related cases.
- To summarize the efficacy of antiplatelets, anticoagulants, thrombolysis, and mechanical thrombectomy.
- To provide guidance on CVT treatment relevant to clinical practice.
Main Methods:
- Literature review of MEDLINE, PubMed, and Cochrane Reviews.
- Searched using terms for CVT and various antiplatelet, anticoagulant, and interventional therapies.
- Synthesized evidence on treatment safety and effectiveness.
Main Results:
- Low-molecular-weight heparin (LMWH) and unfractionated heparin (UH) are first-line treatments for acute CVT.
- Warfarin has weak evidence for secondary prevention; DOACs are potential alternatives.
- COVID-19 CVT management mirrors non-COVID-19 CVT, while vaccine-related CVT requires anticoagulants, immunotherapy, and steroids.
- Antiplatelets have limited evidence for CVT.
- Mechanical thrombectomy and decompressive craniectomy are reserved for complex or life-threatening cases.
Conclusions:
- Heparins are safe and effective for acute CVT.
- Treatment for vaccine-related CVT differs significantly from other CVT types.
- Further research is needed for antiplatelet and endovascular therapies in CVT.
Abstract:
Cerebral venous thrombosis (CVT) is an uncommon cause of stroke. COVID-19 infection and vaccination have been associated with CVT. Fibrinolysis and mechanical thrombectomy may play an emerging role in management. We conducted a literature review summarizing current evidence on use of antiplatelets, anticoagulants, thrombolysis, and mechanical thrombectomy for the management of CVT and COVID-19 related CVT. This was achieved through a review of MEDLINE, PubMed, and Cochrane Reviews databases, performed using the search terms CVT AND "antiplatelets' aspirin", "ticagrelor", "clopidogrel", "eptifibatide", "Low-molecular-weight-heparin (LMWH)", "Unfractionated heparin (UH)", "warfarin", "DOACs", "rivaroxaban", "apixaban", "dabigatran", "fibrinolysis", "intra-sinus thrombolysis", "mechanical thrombectomy", and "craniectomy". We found that LMWH and UH are safe and effective for the management of acute CVT and should be considered first line. Warfarin may be used in the sub-acute phase for secondary prevention but has weak evidence. DOACs are potentially a safe warfarin alternative, but only warfarin is currently recommended in international guidelines. Antiplatelets show little evidence for the prevention or management of CVT, but studies are currently limited. COVID-19 related CVT is treated similarly to non-COVID-19 CVT; however, vaccine-related CVT is a newly recognised disease with a different pathophysiology and is treated with a combination of non-heparin anticoagulants, immunotherapy, and steroids. Decompressive craniectomy may be used to reduce intracranial pressure in life-threatening cases. There is a small body of evidence for endovascular therapy in complex cases but should be reserved for complex cases in specialist centres. This paper is of relevance to clinical practice since the safe and effective management of CVT is important to reduce the risk of disability.
