Elsevier

The Lancet

Volume 338, Issue 8767, 7 September 1991, Pages 597-600
The Lancet

ORIGINAL ARTICLES
Heparin treatment in sinus venous thrombosis

https://doi.org/10.1016/0140-6736(91)90607-QGet rights and content

Abstract

Treatment of sinus venous thrombosis (SVT) is controversial. Although heparin has been used for this condition, many investigators have opposed its use because of the frequent occurrence of intracranial haemorrhage (ICH) in SVT. Therefore we have evaluated anticoagulation with adjusted-dose intravenous heparin for treatment of aseptic SVT in a randomised, blinded (patient and observer), placebo-controlled study in 20 patients (10 heparin, 10 placebo). The clinical course of the two groups, as judged by a newly designed SVT-severity scale, started to differ in favour of the heparin group after 3 days of treatment (p < 0·05, Mann-Whitney U-test) and the difference remained significant (p < 0·01) after 8 days of treatment. After 3 months, 8 of the heparin-treated patients had a complete clinical recovery and 2 had slight residual neurological deficits. In the placebo group, only 1 patient had a complete recovery, 6 patients had neurological deficits, and 3 patients died (p < 0·01, modified Fisher's exact test). An additional retrospective study on the relation between heparin treatment and I CH in SVT patients was based on 102 patients, 43 of whom had an ICH. 27 of these patients were treated with dose-adjusted, intravenous heparin after the ICH. Of these 27 patients, 4 died (mortality 15%), and 14 patients completely recovered. Of the 13 patients that did not receive heparin after ICH, 9 died (mortality 69%) and only 3 patients completely recovered. We conclude that anticoagulation with dose-adjusted intravenous heparin is an effective treatment in patients with SVT and that ICH is not a contraindication to heparin treatment in these patients.

References (28)

  • M-G. Bousser

    Dural sinus thrombosis

    Lancet

    (1987)
  • Dm Gettelfinger et al.

    Superior sagittal sinus thrombosis

    Arch Neurol

    (1977)
  • B. Estanol et al.

    Intracranial venous thrombosis in young women

    Stroke

    (1979)
  • Rn Nishimura et al.

    Internal cerebral vein thrombosis: a case report

    Arch Neurol

    (1982)
  • Wf Hickey et al.

    Primary cerebral venous thrombosis in patients with cancer—a rarely diagnosed paraneoplastic synrome

    Am J Med

    (1982)
  • M-G. Bousser et al.

    Cerebral venous thrombosis—a review of 38 cases

    Stroke

    (1985)
  • I. Scharrer

    Die Behandlung thrombembolischer Prozesse mit Acetylsalicylsäure

    Radiologe

    (1971)
  • M. Sindou et al.

    Bilateral thrombosis of the transverse sinuses: microsurgical revascularization with venous bypass

    Surg Neurol

    (1980)
  • L. Persson et al.

    Extensive dural sinus thrombosis treated by surgical removal and local streptokinase infusion

    Neurosurgery

    (1990)
  • Df Hanley et al.

    Treatment of sagittal sinus thrombosis associated with cerebral hemorrhage and intracranial hypertension

    Stroke

    (1988)
  • Je Harvey

    Streptokinase therapy and cavernous sinus thrombosis

    Br Med J

    (1974)
  • C. Di Rocco et al.

    Heparin urokinase treatment of aseptic dural sinus thrombosis

    Arch Neurol

    (1981)
  • U. Bogdahn et al.

    Thrombolytische Therapie der Sinusthrombose

  • Cited by (845)

    • Venous sinus thrombosis and pregnancy

      2023, The Brain of the Critically Ill Pregnant Woman
    View all citing articles on Scopus
    View full text