Head trauma is the major risk factor for cerebral sinus-vein thrombosis

Abstract Cerebral sinus vein thrombosis (CSVT) is a rare disease with significant neurological sequellae and high mortality rate. Incidence of CSVT diagnosis in the western world has increased despite the reduced occurrence of infectious sinus thrombosis related to otitis media and mastoiditis. The objective of this study was to identify risk factors that may explain the predisposition to the site specific thrombosis based on patients from a single tertiary medical center. The study included 90 consecutive patients aged 15 and up that were diagnosed with acute CSVT from January 2002 to September 2014 at the Sheba Medical Center. As a control group we used the data extracted from the national trauma registry for the years 2012 and 2013 and from Maccabi Healthcare Services, the second largest health care maintenance organization (HMO) in Israel. Trauma history up to one month prior to diagnosis of CVST was found in 13 (14%) patients (10 men and 3 women). Six patients had skull fractures, the others had blunt trauma. Data from the national trauma registry were used to compute annual age and gender specific head trauma rates. The overall SMR was 941 (p < 0.0001); the separate results for men and women were 1206 and 543, respectively. Another important risk factor was infections confined to the head and neck in 7% of the cases and brain tumor in 8%. At the time of CVST, 23 of 50 (46%) women had a hormonal risk factor. The SMR for OC use was 1.63 (p=0.0298). Prothrombotic polymorphisms were detected in 16 of 63 (25.4%) patients who were tested for factor V Leiden and prothrombin G20210A mutation (OR=3.47, p=0.002) in comparison to 49% in DVT patients (OR=9.95, p<0.0001). In 29 of 90 patients at least one of the risk factors for atherosclerosis (hypertension, diabetes or hypercholesterolemia) was discerned but this was very close to the expected number adjusted for sex and age and SMR was 0.98. None of the risk factors correlated with severity of disease and outcome. These data suggest that search for CVST in patients with recent trauma and headache even after intact head CT is required. The other risk factors, such as hormone related and prothrombotic polymorphisms, were not specific just for CVST and the latter play a lesser role in CVST than in DVT. Disclosures No relevant conflicts of interest to declare.

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Profilaxia de Trombose Venosa Profunda em Doentes com Traumatismo Cranioencefálico

Acta Médica Portuguesa ◽

10.20344/amp.5470 ◽

2015 ◽

Vol 28 (2) ◽

pp. 250

Author(s):

Vinícius Trindade Gomes da Silva ◽

Ricardo Iglesio ◽

Wellingson Silva Paiva ◽

Mario Gilberto Siqueira ◽

Manoel Jacobsen Teixeira

Keyword(s):

Traumatic Brain Injury ◽

Risk Factor ◽

Deep Vein Thrombosis ◽

Brain Injury ◽

Head Trauma ◽

Thrombosis Prophylaxis ◽

Mechanical Prophylaxis ◽

Vein Thrombosis ◽

Deep Vein Thrombosis Prophylaxis ◽

Deep Vein

Introduction: The risk of deep vein thrombosis is increased in patients with head trauma, but the prophylaxis against this event is confronted with the possible risk of worsening hemorrhagic injuries. In this article, we present an overview about deep vein thrombosis prophylaxis in patients with head trauma and we propose a practical protocol for clinical management of deep vein thrombosis prophylaxis. Material and Methods: We reviewed relevant papers cited in the Medline/PubMed, Cochrane, and Scielo databases from January 1998 to January 2014. Based on a search with the following search expression: “deep venous thrombosis and prophylaxis and traumatic brain injury”, we found 44 eligible articles. Twenty-three papers were selected using criteria as published in English or Portuguese, patients in acute phase of moderate and severe traumatic brain injury and noninvasive mechanical prophylaxis or chemistry. Results: Head trauma alone is a risk factor for deep vein thrombosis. The chance of deep vein thrombosis is 2.59 times higher in patients with head trauma. The prevalence of deep vein thrombosis and pulmonary embolism in patients who have suffered head trauma is 20% in the literature, reaching 30% in some studies. Discussion and Conclusion: Head trauma alone is a risk factor for deep vein thrombosis and pulmonary thromboembolism and the risks inherent in this disease requires methods of prevention for these complications. Clinical trials are needed to establish the efficacy of prophylaxis and the best time to start medication for deep vein thrombosis in patients with traumatic brain injury.

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