Cerebral venous sinus thrombosis guidelines [Neurosurgery Wiki]

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====== Cerebral venous sinus thrombosis guidelines ======


The [[American Stroke Association]] and the [[European Stroke Organization]] have established [[guideline]]s on [[cerebral venous thrombosis]] (CVT), however, questions remain when an individual case does not fall within the inclusion criteria upon which these [[guideline]]s are based. This is relevant when considering the use of [[anticoagulation]] in cases of [[CVT]] regarding whether or not associated hemorrhage is present and whether the hemorrhage is currently expanding.

Certain cases may fall outside of the study parameters upon which guidelines are constructed, and clinicians should be aware of these exceptions
((Polster SP, Lyne SB, Mansour A. A Case Demonstrating the Nuances of Acute
Cortical Venous Thrombosis Anticoagulation Guidelines. World Neurosurg. 2020 Apr 
15. pii: S1878-8750(20)30691-4. doi: 10.1016/j.wneu.2020.03.220. [Epub ahead of
print] PubMed PMID: 32304887.
)).

===== Timing =====
Current guidelines recommend [[anticoagulation]] after [[cerebral venous sinus thrombosis]] (CVT) even in the setting of intracranial hemorrhage, but the timing of initiation is unclear.

A literature review demonstrated a wide variation of timing for anticoagulation initiation in patients with CVT and intracranial hemorrhage. Most started anticoagulation within 24 hours of admission with similar functional neurological recovery. Current guidelines on the treatment of CVT, even with intracranial hemorrhage, recommend anticoagulation. Most reports in the literature state initiation of anticoagulation within 24 hours. However, the literature does not definitively state when to initiate anticoagulation in a patient with CVT, intracranial hemorrhage, thrombectomy, and decompressive hemicraniectomy
((Pizzi MA, Alejos DA, Siegel JL, Kim BY, Miller DA, Freeman WD. Cerebral Venous
Thrombosis Associated with Intracranial Hemorrhage and Timing of Anticoagulation 
after Hemicraniectomy. J Stroke Cerebrovasc Dis. 2016 Jun 16. pii:
S1052-3057(16)30098-2. doi: 10.1016/j.jstrokecerebrovasdis.2016.05.025. [Epub
ahead of print] PubMed PMID: 27321968.
)).