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Controversies in Neurology |

Sinus Thrombosis Should Be Treated With Anticoagulation

J. Stam, MD, PhD
Arch Neurol. 2008;65(7):984-985. doi:10.1001/archneur.65.7.984.
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The treatment of cerebral venous sinus thrombosis (CVST) with heparin has been controversial for decades, but most experts now agree that most patients with CVST should receive rapid and full anticoagulation as soon as the diagnosis is made. Physicians who do not see many cases of CVST would be surprised to find out there is a dilemma at all. Treatment with anticoagulants for venous thrombosis in the legs and for pulmonary embolism is standard practice based on sound evidence. Adequately dosed heparin or, even better, full-dose low molecular weight preparations followed by some months of oral anticoagulants will prevent the extension of the thrombus and allow for natural recanalization. So why should CVST be an exception? The reason, of course, is the fear of cerebral hemorrhages. This concern is based on the fact that 30% to 40% of all patients with CVST have some degree of cerebral hemorrhage at the time of diagnosis.1 To explain this combination of thrombosis and hemorrhage, it is useful to consider briefly the pathophysiology of CVST.

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