The use of new anticoagulants in cerebral venous thrombosis

Mapping Intimacies ◽

10.5327/1516-3180.416 ◽

2021 ◽

Author(s):

Letícia Luísa Mattos ◽

Amanda Mendes Clemente Vilella

Keyword(s):

Venous Thrombosis ◽

Young Women ◽

Cerebral Venous Thrombosis ◽

Lower Risk ◽

Case Reports ◽

High Recovery ◽

Risk Of Bleeding ◽

New Anticoagulants ◽

Hemorrhagic Complications ◽

Primary Focus

Background: Cerebral venous thrombosis (CVT) is still documented as a rare disease that affects less than 1% of the population, mainly young women. Symptoms are nonspecific, easily confused with less severe pathologies, with a primary focus on headache, which requires attention and knowledge from professionals. The diagnosis is made possible by the use of complementary exams, when the diagnosis is made early, it is of high recovery. In case of late diagnosis or incorrect treatment, the sequelae may be irreversible. Objectives and methodology: to analyze the use of new anticoagulants (NOACs) in relation to treatment with warfarin in cases of CVT, through narrative review. Studies from the years 2015-2020 were used in the following databases: Pubmed, Scielo and Medline. Results: Studies from the last 5 years, composed mainly of case reports and multicentric analyzes, report non-inferiority of the outcome when treatments are compared or better outcome with NOACs due to the lower risk of bleeding. However, the European Stroke Organization in its last guideline (2017) does not recommend the use, especially during the acute phase. Conclusions: CVT can affect patients of various ages, so knowledge of the best therapy is essential. Currently, the use of warfarin and heparin is still recommended for acute cases, assessing the risk of complications such as bleeding. In view of the possible safety of new anticoagulants in view of the risk of hemorrhagic complications, further studies of non-inferiority in relation to warfarin are necessary so that the best approach is employed for these patients.

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Successful Endovascular Treatment of Cerebral Venous Thrombosis With a Novel, Larger Aspiration Catheter (REACT): A Case Report

Neurointervention ◽

10.5469/neuroint.2020.00304 ◽

2020 ◽

Author(s):

Kaushik Sundar ◽

Sabharisundarvel Paulraj ◽

Shuvro Roy Choudhury ◽

Haseeb Hassan ◽

Judhajit Sengupta ◽

...

Keyword(s):

Venous Thrombosis ◽

Medical Management ◽

Cerebral Venous Thrombosis ◽

Lower Risk ◽

Mechanical Thrombectomy ◽

Treatment Options ◽

Rare Clinical Entity ◽

Modified Rankin Scale ◽

Clinical Presentations ◽

Hemorrhagic Complications

Cerebral venous thrombosis (CVT) is a rare clinical entity, with clinical presentations extending from headache and seizures to coma and death. For adults developing progressive neurological worsening despite adequate medical management, endovascular thrombolysis and/or mechanical thrombectomy may be considered as treatment options. We present one such patient with CVT who developed seizures and slipped into a coma, despite best medical management. A large-bore aspiration catheter was used as a standalone system for the endovascular procedure. The venous sinuses were successfully re-canalized. The patient was discharged a week later with a modified Rankin scale of 2. Studies show that endovascular thrombolysis used alone or in conjunction with thrombectomy for CVT has a higher risk of hemorrhagic complications. If we were to use mechanical thrombectomy devices (that are specifically designed for intracranial clot retrieval) as a stand-alone system, we would probably have better clinical outcomes with a lower risk of hemorrhagic complications.

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Thyroid dysfunction in cerebral venous thrombosis: a retrospective cohort study

Journal of Neurology ◽

10.1007/s00415-021-10776-3 ◽

2021 ◽

Author(s):

Simon Fandler-Höfler ◽

Stefan Pilz ◽

Marion Ertler ◽

Melanie Haidegger ◽

Markus Kneihsl ◽

...

Keyword(s):

Confidence Interval ◽

Venous Thrombosis ◽

Cerebral Venous Thrombosis ◽

Thyroid Dysfunction ◽

Case Reports ◽

Hormone Replacement ◽

Thyroid Stimulating Hormone ◽

Medical Documentation ◽

Newly Diagnosed ◽

Documentation System

Abstract Background Cerebral venous thrombosis (CVT) is a multifactorial disease with a variety of related conditions and risk factors. Thyroid dysfunction—especially hyperthyroidism—has been linked to CVT, but this is mainly based on case reports ranging back to 1913, while systematic investigations addressing this issue are lacking. Therefore, we investigated the frequency and clinical characteristics of thyroid dysfunction in a large single-center cohort of CVT patients. Methods We retrospectively identified all consecutive patients with aseptic CVT treated at our center between 2006 and 2020. Clinical information was extracted from our electronic medical documentation system. Thyroid-stimulating hormone (TSH) had been routinely measured at admission, free thyroid hormones and thyroid autoantibodies were analyzed whenever available. Results Of 120 patients with imaging-confirmed CVT, our main analysis included 107 patients (mean age 42 ± 16 years, 74% female) in whom TSH measurements were available. Nineteen patients (17.8%, 95% confidence interval 10–25%) had thyroid dysfunction. Two had newly diagnosed hyperthyroidism (1.9%, 95% confidence interval 0–4%) caused by Graves’ disease, but without typical symptoms for this condition. Seventeen patients (15.9%, 95% confidence interval 9–23%) had hypothyroidism (12 previously diagnosed with ongoing thyroid hormone replacement therapy; 5 with newly diagnosed subclinical hypothyroidism). Clinical CVT characteristics were similar comparing patients with versus without thyroid dysfunction. Conclusion We observed a remarkably high prevalence of thyroid dysfunction in CVT patients. Whether this finding reflects a causal relationship warrants further studies. Despite that, the frequent coexistence of both diseases argues for TSH screening in CVT patients.

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Cerebral venous thrombosis secondary to an occult maxillary sinusitis in a young male from sub-Saharan Africa

10.36811/ojor.2019.110002 ◽

2019 ◽

pp. 08-12

Author(s):

Mazou N Temgoua ◽

Mickael Essouma ◽

Larry N Tangie ◽

Cedric Tsinda ◽

Drusille Feze Foko ◽

...

Keyword(s):

Venous Thrombosis ◽

Acute Stroke ◽

Cerebral Venous Thrombosis ◽

Fungal Infections ◽

Sinus Thrombosis ◽

Maxillary Sinusitis ◽

Case Reports ◽

Sub Saharan Africa ◽

First Case ◽

Increased Risk

Cerebral venous thrombosis (CVT) also termed cerebral venous sinus thrombosis (CVST), is a special type of cerebrovascular disease characterized by cerebral venous infarction [1]. As from 1825 when the first case was described by Ribes[2], epidemiological descriptions are still restricted to case reports and small retrospective cross-sectional studies yielding low butincreasing incidence: <10 cases per million per year in 1995 to about 13.2 cases per million per year in 2012.CVT mainly occurs in women of child bearing age, probably owing to the use of oral contraceptive pills, and mostly has an acute or subacute course [1]. It can be categorized as primary/idiopathicand secondary. Secondary CVT can further be classified into infective (mainly due to bacterial or fungal infections) and non-infective CVT; the latterbeing due tocoagulation disorders, neoplasms, procoagulant hemodynamic states, vascularitis,homocystinuria, or head trauma [3].With the advent of antibiotics, the epidemiology of CVT has shifted from predominant infective CVT to predominant non-infective CVT, leading to increased risk of misdiagnosis and delayed treatment [3]. We report occult purulent maxillary sinusitis-related CVT in a male Cameroonian patient who presented with headaches, seizures and acute stroke syndrome. The aim of this paper is to reiterate CVT as the main cause of acute stroke syndrome in young adults irrespective of ethnic origin and sex, and suggest systematic screening of infections in those patients, especially in regions with high rates of infections likesub-Saharan Africa.We describe this case with regard to CARE guidelines.

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