Anticoagulation for cerebral sinus thrombosis

  • Comment
  • Review
  • Intervention

Authors


Abstract

Background

Treatment of cerebral sinus thrombosis with anticoagulants has been controversial. Anticoagulants may prevent new venous infarcts, neurologic deterioration, and pulmonary embolism but may also promote haemorrhages.

Objectives

To assess the effectiveness and safety of anticoagulant therapy in patients with confirmed cerebral sinus thrombosis.

Search strategy

We searched the Cochrane Stroke Group Trials Register (last searched 18 March 2002). We also searched MEDLINE (1966 to October 2001), EMBASE (1980 to February 2002) and the Cochrane Controlled Trials Register (The Cochrane Library, 2002 Issue 1) and contacted authors to identify additional published and unpublished studies.

Selection criteria

Unconfounded randomised 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 analysis

Two reviewers independently extracted outcomes for each of the two treatment groups (anticoagulant treatment and control). The outcome data for each patient are analysed 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) is calculated using the Cochrane statistical software.

Main results

Two 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). No new symptomatic intracerebral haemorrhages were observed. One major gastro-intestinal haemorrhage occurred after anticoagulant treatment. Two control patients (placebo) had a diagnosis of probable pulmonary embolism (one fatal).

Authors' conclusions

Based upon 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.

Plain language summary

Anticoagulation for cerebral sinus thrombosis

Anticoagulants may improve outcome after cerebral sinus thrombosis. Blood thinning (anticoagulant) drugs may be beneficial for patients with clotting of the veins that surround the brain (sinus thrombosis). Sinus thrombosis is a rare condition where blood clots form in the veins that drain blood from the brain. Blood thinning (anticoagulant) drugs which are often used to treat sinus thrombosis carry a risk of bleeding. Only two small trials could be found which suggested that anticoagulant drugs are probably safe and may be beneficial for people with sinus thrombosis but results are not conclusive.

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