Cerebral venous sinus thrombosis guidelines

The American Stroke Association and the European Stroke Organization have established guidelines on cerebral venous thrombosis (CVT), however, questions remain when an individual case does not fall within the inclusion criteria upon which these guidelines 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 ¹⁾.

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 ²⁾.