Evidence-based Treatment for a Patient with Cerebral Veins and Sinuses Thrombosis_Chinese Journal of Evidence-Based Medicine

Authors：

FANG Yuan ,  LIU Ming , WU Bo , ZHANG Shihong

Department of Neurology, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LIU Ming, Email: wyplmh@hotmail.com

Keywords：

Cerebral veins and sinuses thrombosis; Thrombolysis; Anticoagulation; Evidence-based treatment

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Objective 　To make an evidence-based remedy for a patient with cerebral veins and sinuses thrombosis (CVST), who had an unsatisfactory response to routine treatment.
Methods　 We searched the Cochrane Library (Issue 3, 2005), PubMed (1966 to 2005), CNKI (1979 to 2005) and VIP (1989 to 2005) to identify systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies about efficacy and safety of anticoagulants and thrombolysis therapy for CVST.
Results 　We found 1 systematic review, 3 RCTs and 8 prospective cohort studies about anticoagulation therapy and 2 SRs and 1 CCT about thrombolysis therapy. Routine anticoagulation and thrombolysis for patients with CVST are not recommended due to insufficient evidence. Anticoagulation appeared to be safer and could prevent pulmonary embolism. According to the current evidence, the patient’s status and will, anticoagulants were given. His symptoms relieved and he had no subsequent hemorrhages or pulmonary embolism.
Conclusion 　Patients with CVST should receive anticoagulation treatment with monitoring of de novo hemorrhages and the index of hemostasis and coagulation. Large-sample RCTs comparing the effect and safety of anticoagulant with placebo and RCTs comparing the effect and safety of anticoagulation therapy with that of endovascular thrombolysis therapy in high-risk patients are needed.

Citation： FANG Yuan,LIU Ming,WU Bo,ZHANG Shihong. Evidence-based Treatment for a Patient with Cerebral Veins and Sinuses Thrombosis. Chinese Journal of Evidence-Based Medicine, 2006, 06(3): 226-230. doi: Copy

1.	刘鸣, 李静. 循证医学与临床实践. 见: 王家良, 刘鸣, 主编. 循证医学. 第1版. 北京: 人民卫生出版社; 2001. 198~200.
2.	Ferro JM, Canhao P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke, 2004; 35(3): 664-670.
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4.	Einhaupl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet, 1991; 338(8767): 597-600.
5.	de Bruijn SF, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke, 1999; 30(3): 484-488.
6.	Nagaraja D, Rao BSS, Taly AB, et al. Randomized controlled trial of heparin in puerperal cerebral venous/sinus thrombosis. Nimhans J, 1995; 13(2): 111-115.
7.	de Bruijn SF, de Haan RJ, Stam J. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group. J Neurol Neurosurg Psychiatry, 2001; 70(1): 105-108.
8.	Ferro JM, Lopes MG, Rosas MJ, et al. Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study. Cerebrovasc Dis, 2002; 13(4): 272-278.
9.	Breteau G, Mounier-Vehier F, Godefroy O, et al. Cerebral venous thrombosis 3-year clinical outcome in 55 consecutive patients. J Neurol, 2003; 250(1): 29-35.
10.	Baumgartner RW, Studer A, Arnold M, et al. Recanalisation of cerebral venous thrombosis. J Neurol Neurosurg Psychiatry, 2003; 74(4): 459-461.
11.	Cakmak S, Derex L, Berruyer M, et al. Cerebral venous thrombosis: clinical outcome and systematic screening of prothrombotic factors. Neurology, 2003; 60(7): 1175-1178.
12.	Stolz E, Trittmacher S, Rahimi A, et al. Influence of recanalization on outcome in dural sinus thrombosis: a prospective study. Stroke, 2004; 35(2): 544-547.
13.	Stolz E, Rahimi A, Gerriets T, et al. Cerebral venous thrombosis: an all or nothing disease? Prognostic factors and long-term outcome. Clin Neurol Neurosurg, 2005; 107(2): 99-107.
14.	Ciccone A, Canhao P, Falcao F, et al. Thrombolysis for cerebral vein and dural sinus thrombosis. In: The Cochrane Database of Systematic Reviews, Issue 3, 2005. Hoboken: John Wiley & Sons Inc; 2005.
15.	Canhao P, Falcao F, Ferro JM. Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovascular Diseases, 2003; 15(3): 159-166.
16.	Wasay M, Bakshi R, Kojan S, et al. Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis. Stroke, 2001; 32(10): 2310-2317.
17.	Liu M, Li J. Evidence-based medicine and clinical practice. In: Wang JL, Liu M, eds. Evidence-Based Medicine. 1st ed. Beijing: People’s medical publishing house; 2001. 198-200.
18.	van den Belt A, Prins MH, Lensing AW, et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. In: The Cochrane Database of Systematic Reviews, Issue 3, 2005. Hoboken: John Wiley & Sons Inc; 2005.

1. 刘鸣, 李静. 循证医学与临床实践. 见: 王家良, 刘鸣, 主编. 循证医学. 第1版. 北京: 人民卫生出版社; 2001. 198~200.
2. Ferro JM, Canhao P, Stam J, et al. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke, 2004; 35(3): 664-670.
3. Stam J, De Bruijn SF, DeVeber G. Anticoagulation for cerebral sinus thrombosis. In: The Cochrane Database of Systematic Reviews, Issue 3, 2005. Hoboken: John Wiley & Sons Inc; 2005.
4. Einhaupl KM, Villringer A, Meister W, et al. Heparin treatment in sinus venous thrombosis. Lancet, 1991; 338(8767): 597-600.
5. de Bruijn SF, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke, 1999; 30(3): 484-488.
6. Nagaraja D, Rao BSS, Taly AB, et al. Randomized controlled trial of heparin in puerperal cerebral venous/sinus thrombosis. Nimhans J, 1995; 13(2): 111-115.
7. de Bruijn SF, de Haan RJ, Stam J. Clinical features and prognostic factors of cerebral venous sinus thrombosis in a prospective series of 59 patients. For The Cerebral Venous Sinus Thrombosis Study Group. J Neurol Neurosurg Psychiatry, 2001; 70(1): 105-108.
8. Ferro JM, Lopes MG, Rosas MJ, et al. Long-term prognosis of cerebral vein and dural sinus thrombosis. results of the VENOPORT study. Cerebrovasc Dis, 2002; 13(4): 272-278.
9. Breteau G, Mounier-Vehier F, Godefroy O, et al. Cerebral venous thrombosis 3-year clinical outcome in 55 consecutive patients. J Neurol, 2003; 250(1): 29-35.
10. Baumgartner RW, Studer A, Arnold M, et al. Recanalisation of cerebral venous thrombosis. J Neurol Neurosurg Psychiatry, 2003; 74(4): 459-461.
11. Cakmak S, Derex L, Berruyer M, et al. Cerebral venous thrombosis: clinical outcome and systematic screening of prothrombotic factors. Neurology, 2003; 60(7): 1175-1178.
12. Stolz E, Trittmacher S, Rahimi A, et al. Influence of recanalization on outcome in dural sinus thrombosis: a prospective study. Stroke, 2004; 35(2): 544-547.
13. Stolz E, Rahimi A, Gerriets T, et al. Cerebral venous thrombosis: an all or nothing disease? Prognostic factors and long-term outcome. Clin Neurol Neurosurg, 2005; 107(2): 99-107.
14. Ciccone A, Canhao P, Falcao F, et al. Thrombolysis for cerebral vein and dural sinus thrombosis. In: The Cochrane Database of Systematic Reviews, Issue 3, 2005. Hoboken: John Wiley & Sons Inc; 2005.
15. Canhao P, Falcao F, Ferro JM. Thrombolytics for cerebral sinus thrombosis: a systematic review. Cerebrovascular Diseases, 2003; 15(3): 159-166.
16. Wasay M, Bakshi R, Kojan S, et al. Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis. Stroke, 2001; 32(10): 2310-2317.
17. Liu M, Li J. Evidence-based medicine and clinical practice. In: Wang JL, Liu M, eds. Evidence-Based Medicine. 1st ed. Beijing: People’s medical publishing house; 2001. 198-200.
18. van den Belt A, Prins MH, Lensing AW, et al. Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. In: The Cochrane Database of Systematic Reviews, Issue 3, 2005. Hoboken: John Wiley & Sons Inc; 2005.

Chinese Journal of Evidence-Based Medicine

Evidence-based Treatment for a Patient with Cerebral Veins and Sinuses Thrombosis

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