Initial management of a patient diagnosed with cerebral venous sinus thrombosis (CVST) involves prompt initiation of full-dose anticoagulation therapy, even in the presence of secondary cerebral haemorrhage, unless contraindications exist. The recommended anticoagulation is initially with full-dose heparin (usually low molecular weight heparin) followed by oral anticoagulation with warfarin targeting an international normalised ratio (INR) of 2 to 3. This approach aims to prevent thrombus propagation and facilitate recanalisation of the affected venous sinuses NICE NG158,NICE NG128.
Assessment for contraindications to anticoagulation, such as significant comorbidities or bleeding risk, is essential before starting treatment. If anticoagulation is contraindicated, alternative mechanical interventions may be considered, although these are less commonly used NICE NG158.
During anticoagulation, close monitoring is required to balance the risk of bleeding against the benefits of preventing further thrombosis. In cases where direct oral anticoagulants (DOACs) are considered unsuitable, the standard regimen remains low molecular weight heparin followed by vitamin K antagonists NICE NG158.
Additional supportive care includes managing intracranial pressure, seizures, and any underlying causes or risk factors for CVST. Early involvement of neurology or stroke specialists is recommended to guide comprehensive management NICE NG158[Fan et al. 2020].
Key References
- NG158 - Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
- NG128 - Stroke and transient ischaemic attack in over 16s: diagnosis and initial management
- (Fan et al., 2020): Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis.