Anticoagulation for Cerebral Sinus Thrombosis
2003; Lippincott Williams & Wilkins; Volume: 34; Issue: 4 Linguagem: Inglês
10.1161/01.str.0000062344.87396.72
ISSN1524-4628
AutoresJ. Stam, S. de Bruijn, Gabrielle deVeber,
Tópico(s)Intracerebral and Subarachnoid Hemorrhage Research
ResumoHomeStrokeVol. 34, No. 4Anticoagulation for Cerebral Sinus Thrombosis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBAnticoagulation for Cerebral Sinus Thrombosis Jan Stam, Sebastian de Bruijn and Gabrielle deVeber Jan StamJan Stam From the Department of Neurology, Academic Medical Centre, University of Amsterdam. , Sebastian de BruijnSebastian de Bruijn From the Department of Neurology, Academic Medical Centre, University of Amsterdam. and Gabrielle deVeberGabrielle deVeber From the Department of Neurology, Academic Medical Centre, University of Amsterdam. Originally published20 Mar 2003https://doi.org/10.1161/01.STR.0000062344.87396.72Stroke. 2003;34:1054–1055Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: March 20, 2003: Previous Version 1 BackgroundTreatment of cerebral sinus thrombosis with anticoagulants has been controversial. Anticoagulants may prevent new venous infarcts, neurologic deterioration, and pulmonary embolism but may also promote hemorrhages.ObjectivesTo review the available evidence regarding the effectiveness and safety of anticoagulant therapy in patients with confirmed cerebral sinus thrombosis.Search StrategyWe searched the Cochrane Stroke Group Trials Register (last searched March 18, 2002). We also searched MEDLINE (1966 to October 2001), EMBASE (1980 to February 2002), and the Cochrane Controlled Trials Register (Cochrane Library, 2002 Issue 1) and contacted authors to identify additional published and unpublished studies.Selection CriteriaUnconfounded randomized controlled trials in which anticoagulant therapy was compared with placebo or open control in patients with cerebral sinus thrombosis (confirmed by intra-arterial contrast or magnetic resonance angiography).Data Collection and AnalysisTwo reviewers independently extracted outcomes for each of the 2 treatment groups (anticoagulant treatment and control) and analyzed the outcome data for each patient in the treatment group to which the patient was originally allocated ("intention-to-treat" analysis). A weighted estimate of the treatment effects across trials (relative risk, absolute risk reduction) was calculated using the Cochrane statistical software.Main ResultsTwo small trials involving 79 patients fulfilled the inclusion criteria. One trial (20 patients) examined the efficacy of intravenous, adjusted-dose, unfractionated heparin. The other trial (59 patients) examined high-dose, body-weight-adjusted, subcutaneous, low-molecular-weight heparin (nadroparin). Anticoagulant therapy was associated with a pooled relative risk of death of 0.33 (95% CI 0.08 to 1.21) and of death or dependency of 0.46 (95% CI 0.16 to 1.31) (the Figure). No new symptomatic intracerebral hemorrhages were observed. One major gastrointestinal hemorrhage occurred after anticoagulant treatment. Two control patients (placebo) had a diagnosis of probable pulmonary embolism (one fatal). Download figureDownload PowerPointSystematic review of trials comparing therapeutic dose of heparin with placebo for cerebral sinus thrombosis. Results are expressed as relative risks (RR) with 95% CIs. (Figure 01.02.00. Stam J, de Bruijn SFTM, DeVeber G. Anticoagulation for cerebral sinus thrombosis (Cochrane review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software. MetaView © Update Software, Oxford.)Two trials were excluded. One study has been published only as an abstract, and another trial did not meet our inclusion criterion of diagnostic confirmation by x-ray or MR angiography. The latter study showed a statistically nonsignificant benefit of heparin compared with placebo.Implications for PracticeAnticoagulant treatment in patients with cerebral sinus thrombosis appears to be safe and is associated with an apparent reduction in the risk of death or dependency, which did not reach statistical significance. In the absence of more information from randomized trials, clinicians will need to base their treatment decisions on the limited information available.Implications for ResearchAlthough the estimated pooled risk reductions did not reach statistical significance, patients and doctors may be reluctant to embark on a new trial that includes a placebo group. Reliable data about the occurrence of intracerebral hemorrhages after anticoagulant treatment in consecutive series of patients with CVST are needed to obtain more robust estimations of the risk. Large consecutive cohort studies could also help to identify subgroups of patients with a poor prognosis. In such patients, randomized trials testing more aggressive—and probably more hazardous—therapies such as local (direct) thrombolysis or thrombosuction are justified and needed.Reviewers' ConclusionsBased on the limited evidence available, anticoagulant treatment for cerebral sinus thrombosis appeared to be safe and was associated with a potentially important reduction in the risk of death or dependency, which did not reach statistical significance.Note: The full text of this review is available in the Cochrane Library (for subscribers: www.update-software. com/Cochrane). The full article should be cited as: Stam J, de Bruijn SFTM, DeVeber G. Anticoagulation for cerebral sinus thrombosis (Cochrane review). In: The Cochrane Library, Issue 4, 2002. Oxford: Update Software.Section Editor: Graeme J. Hankey, MD, FRACPFootnotesCorrespondence to Prof J. Stam, Academic Medical Centre, PO Box 22700, 1100 DE Amsterdam, the Netherlands. E-mail [email protected] eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetailsCited By Abou-Al-Shaar H, Gozal Y, Alzhrani G, Karsy M, Shelton C and Couldwell W Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines, Neurosurgical Focus, 10.3171/2018.4.FOCUS18112, 45:1, (E4) Vaishnavi B and Subathra Devi C (2017) Potential application of immobilized streptokinase extracted from Streptococcus equinus VIT_VB2 , Preparative Biochemistry & Biotechnology, 10.1080/10826068.2017.1373291, 47:10, (1032-1036), Online publication date: 26-Nov-2017. 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