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Meta-Analysis
. 2011 Aug 10;2011(8):CD002005.
doi: 10.1002/14651858.CD002005.pub2.

Anticoagulation for cerebral venous sinus thrombosis

Jonathan Coutinho  1 , Sebastiaan Ftm de Bruijn, Gabrielle Deveber, Jan Stam
Affiliations
Meta-Analysis

Anticoagulation for cerebral venous sinus thrombosis

Jonathan Coutinho et al. Cochrane Database Syst Rev. .

Abstract

Background: Treatment of cerebral venous 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 venous sinus thrombosis.

Search strategy: We searched the Cochrane Stroke Group Trials Register (last searched August 2010), MEDLINE (1950 to August 2010), EMBASE (1980 to August 2010) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2011 Issue 1). In an effort to identify further published, unpublished and ongoing trials we searched ongoing trials registers and reference lists of relevant articles, and contacted authors.

Selection criteria: Unconfounded randomised controlled trials in which anticoagulant therapy was compared with placebo or open control in patients with cerebral venous sinus thrombosis (confirmed by intra-arterial contrast, or venography with magnetic resonance, or venography with computed tomography imaging).

Data collection and analysis: Two review authors independently extracted outcomes for each of the two treatment groups (anticoagulant treatment and control). The outcome data for each patient were analysed in the treatment group to which the patient was originally allocated (intention-to-treat analysis). We calculated a weighted estimate of the treatment effects across trials (relative risk, absolute risk reduction).

Main results: We included two small trials involving 79 patients. 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% confidence interval (CI) 0.08 to 1.21) and of death or dependency of 0.46 (95% CI 0.16 to 1.31). The absolute reduction in the risk of death or dependency was 13% (95% CI 30% to -3%). 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 venous 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.

PubMed Disclaimer

Conflict of interest statement

SFTM de Bruijn and J Stam were principal investigators of the CVST Study Group Trial (CVST Group 1999).

Figures

1.1
1.1. Analysis
Comparison 1 Overall benefit or harm of (LMW) heparin, Outcome 1 Death.
1.2
1.2. Analysis
Comparison 1 Overall benefit or harm of (LMW) heparin, Outcome 2 Death or dependency.
2.1
2.1. Analysis
Comparison 2 Haemorrhagic adverse events, Outcome 1 Symptomatic intracerebral haemorrhage (new or increased).
2.2
2.2. Analysis
Comparison 2 Haemorrhagic adverse events, Outcome 2 Any severe haemorrhage.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

CVST Group 1999 {published data only}
    1. Bruijn SFTM, Stam J, for the Cerebral Venous Sinus Thrombosis Study Group. Randomised, placebo‐controlled trial of anticoagulant treatment with low‐molecular weight heparin for cerebral sinus thrombosis. Stroke 1999;30:484‐8. - PubMed
Einhaupl 1991 {published data only}
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References to studies excluded from this review

Maiti 1997 {published data only}
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References to studies awaiting assessment

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