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BACKGROUND AND PURPOSE: More evidence supports the benefits of batroxobin combined with anticoagulation in correcting acute cerebral venous thrombosis (CVT). The dynamic fluctuations of peripheral blood platelets, fibrinolysis, and coagulation biomarkers during this therapy were analyzed. METHODS: We investigated batroxobin's effects on the antithrombotic system under two regimens. The pretreatment group included patients on anticoagulants for at least 1 week before starting batroxobin. The simultaneous treatment group began both treatments upon admission. The control group received only anticoagulation. Batroxobin was given on alternate days at doses of 10BU, 5BU, and 5BU, totaling three doses. Anticoagulation was continuous. Baseline data were T0; the next day after each batroxobin dose was T1, T2, and T3. Data from these four time points was analyzed. RESULTS: The time-point paired sample T-test results of the pretreatment group [n = 60; mean age (SD), 43.3(16.5); 38 (63.35%) women] showed that batroxobin significantly inhibited ADP-induced platelet aggregation rate (T1-T0: p = 0.015; T2-T0: p = 0.025; T3-T0: p = 0.013), decreased fibrinogen level (T1-T0: p < 0.001; T2-T0: p < 0.001; T3-T0: p < 0.001), and increased D-dimer (T1-T0:p < 0.001; T2-T0: p < 0.001; T3-T0: p < 0.001), TT (T1-T0:p = 0.046; T2-T0: p = 0.003; T3-T0: p < 0.001), and APTT (T1-T0:p = 0.021; T2-T0: p = 0.012; T3-T0: p = 0.026). Compared to the control group, the simultaneous treatment group showed significantly higher TT (T2: p = 0.002; T3: p = 0.004) and D-dimer (T1: p < 0.001; T2: p < 0.001; T3: p < 0.001) values, while fibrinogen (T2: p < 0.001; T3: p < 0.001) levels were significantly lower. Using batroxobin can alleviate the amplitude of changes in coagulation indicators other than TT caused by anticoagulants. The above conclusions are consistent with the results of repeated measurement data analysis. CONCLUSIONS: Batroxobin can significantly inhibit ADP-induced platelet aggregation rate, increase D-dimer, decrease fibrinogen, and prolong TT and APTT in the presence of anticoagulant agents. Using batroxobin can reduce the amplitude of changes in coagulation indicators caused by anticoagulants. These results reveal the potential mechanism of batroxobin combined with anticoagulation in the safe and effective treatment of CVT.
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Batroxobina , Trombosis Intracraneal , Trombosis de la Vena , Humanos , Batroxobina/farmacología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/sangre , Trombosis de la Vena/tratamiento farmacológico , Fibrinolíticos/farmacología , Fibrinolíticos/uso terapéutico , Agregación Plaquetaria/efectos de los fármacos , Anticoagulantes/farmacología , Anticoagulantes/uso terapéutico , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Anciano , Plaquetas/efectos de los fármacos , Plaquetas/metabolismoRESUMEN
Parvimonas micra is a gram-positive anaerobic coccus typically found in the human oral cavity, upper respiratory tract and gastrointestinal system. It occasionally causes intra-abdominal abscesses, spondylodiscitis and other infections. There are very few case reports on mycotic aneurysm related to P. micra We describe a rare case of P. micra orbital cellulitis complicated with meningitis, cerebral venous thrombosis and internal carotid artery mycotic aneurysm, which was successfully treated with the combination of endovascular therapy and antibiotics. Additionally, the patient received 6 months of anticoagulation therapy for cerebral venous thrombosis.
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Aneurisma Infectado , Antibacterianos , Celulitis Orbitaria , Humanos , Celulitis Orbitaria/microbiología , Celulitis Orbitaria/complicaciones , Antibacterianos/uso terapéutico , Aneurisma Infectado/complicaciones , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/diagnóstico , Masculino , Firmicutes , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Anticoagulantes/uso terapéutico , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/tratamiento farmacológico , Procedimientos Endovasculares/métodos , FemeninoRESUMEN
Inflammation is pivotal in the pathogenesis and development of cerebral venous thrombosis (CVT). Herein, we aimed to assess the anti-inflammatory effects of batroxobin combined with anticoagulation in CVT. Participants were categorized into the batroxobin group (batroxobin combined with anticoagulation) and the control group (anticoagulation only). Regression analysis was employed to explore the association between the number of episodes of batroxobin administration and the fluctuation of inflammatory indicators, as well as the proportion of patients with inflammatory indicators that were reduced after batroxobin use. Twenty-three cases (age: 39.9 ± 13.8 years, female: 39.1%) in the batroxobin group and 36 cases (40.3 ± 9.6 years, 52.8%) in the control group were analyzed. Compared to the control group, batroxobin combined with anticoagulation significantly decreased fibrinogen (P < .001), platelet-lymphocyte ratio (PLR) (P = .016) and systemic immune-inflammation index (SII) (P = .008), and increased the proportion of the patients with lower fibrinogen (P < .001), neutrophil-lymphocyte ratio (NLR) (P = .005), PLR (P = .026), and SII (P = .006). Linear analysis showed that as the number of episodes of batroxobin administration increased, the fibrinogen (P < .001), the PLR (P = .001), and the SII (P = .020) significantly decreased. Logistic regression analysis showed as the number of episodes of batroxobin administration increased, the ratio of the patients with decreased NLR (P = .008) and PLR (P = .015), as well as SII (P = .013), significantly increased. Batroxobin could decrease NLR, PLR, and SII in CVT. The effect was related to the number of episodes of batroxobin administration. Besides reducing fibrinogen and indirect thrombolysis effects, this may be another critical benefit of batroxobin for CVT.
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Anticoagulantes , Batroxobina , Trombosis Intracraneal , Trombosis de la Vena , Humanos , Femenino , Batroxobina/farmacología , Batroxobina/uso terapéutico , Batroxobina/administración & dosificación , Masculino , Anticoagulantes/uso terapéutico , Anticoagulantes/farmacología , Anticoagulantes/administración & dosificación , Adulto , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/sangre , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/sangre , Persona de Mediana Edad , Antiinflamatorios/farmacología , Antiinflamatorios/uso terapéuticoRESUMEN
Current guidelines recommend the standard-of-care anticoagulation (vitamin K antagonists or low-molecular-weight heparin) in patients with cerebral venous thrombosis (CVT). Herein, we performed a meta-analysis of randomized clinical trials (RCTs) to assess the efficacy and safety of direct oral anticoagulants (DOACs) compared with the current standard of care in patients with CVT. We systematically searched the PubMed and Embase databases up to December 2023 to identify clinical trials on the effect of DOACs in patients with CVT. A Mantel-Haenszel fixed effects model was applied, and the effect measures were expressed as the absolute risk differences (RDs) and 95% confidence intervals (CIs). A total of 4 RCTs involving 270 participants were included. In the pooled analysis, DOACs and standard of care had low incidence rates of recurrent VTE and all-cause death, and similar rates of any recanalization (78.2% vs 83.2%; RD = -4%, 95%CI:-14% to 5%) and complete recanalization (60.9% vs 69.4%; RD = -7%, 95%CI:-24% to 10%). Compared with the standard of care, DOACs had non-significant reductions in the rates of major bleeding (1.2% vs 2.4%; RD = -1%, 95%CI: -6% to 3%), intracranial hemorrhage (1.9% vs 3.6%; RD = -2%, 95%CI:-7% to 3%), clinically relevant non-major bleeding (3.8% vs 7.4%; RD = -4%, 95%CI:-9% to 2%), and any bleeding (17.3% vs 21.4%; RD = -4%, 95%CI:-16% to 8%) in patients with CVT. DOACs and standard of care showed similar efficacy and safety profiles for the treatment of CVT. DOACs might be safe and a convenient alternative to vitamin K antagonists for thromboprophylaxis in patients with CVT.
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Anticoagulantes , Ensayos Clínicos Controlados Aleatorios como Asunto , Trombosis de la Vena , Humanos , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversos , Anticoagulantes/administración & dosificación , Administración Oral , Trombosis de la Vena/tratamiento farmacológico , Trombosis Intracraneal/tratamiento farmacológicoRESUMEN
BACKGROUND: The dramatic clinical improvement offered by mechanical thrombectomy raised questions about the relevance of prior intravenous thrombolysis in large-vessel occlusion strokes. Hence, studying intravenous thrombolysis susceptibility and its dependence on thrombus composition is crucial. We used an observational proteomic study of whole thrombi retrieved by mechanical thrombectomy to identify factors associated with fibrin content and fibrinolytic activity (FA). METHODS: In 104 stroke patients, the thrombi proteome was established by mass spectrometry coupled to liquid chromatography. FA was estimated in clots both outside (FAout) by measuring D-dimer levels at the blood-thrombus interface and inside (FAin) by evaluating the ratio of fibrinogen α to its plasmin-cleaved forms using proteomics coupled with protein electrophoresis. The factors associated with fibrin content, FAin, and FAout were determined by intravenous thrombolysis-adjusted linear regression. RESULTS: FAout (P<0.0001) and FAin (P=0.0147) were driven by recombinant tissue-type plasminogen activator (r-tPA) administration (47/104) and thrombus composition. Indeed, FAout was greater with fibrin-rich than erythrocyte-rich thrombi, presumably because of more (r)tPA substrates. Thus, FAout was increased with cardioembolic thrombi (72/104), which are rich in fibrin (P=0.0300). Opposite results were found inside the thrombus, suggesting that (r)tPA penetrability was hampered by the density of the fibrinous cap. Moreover, blood cells had a strong impact on thrombus structure and susceptibility to (r)tPA. Indeed, fibrin content was negatively associated with erythrocyte-specific proteins in the thrombus, admission hematocrit (P=0.0139), and hemoglobin level (P=0.0080), which underlines the key role of erythrocytes in thrombus composition. Also, an increased number of neutrophils impaired FAout (P=0.0225), which suggests that their aggregation around the thrombus prevented the (r)tPA attack. Only FAout was significantly associated with reduced thrombus weight (P=0.0310), increased recanalization rate (P=0.0150), good clinical outcome (P=0.0480), and reduced mortality (P=0.0080). CONCLUSIONS: Proteomics can offer new insights into the close relationship between thrombus composition and susceptibility to fibrinolysis, paving the way for new adjuvant therapies.
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Fibrinólisis , Trombosis Intracraneal , Proteómica , Accidente Cerebrovascular , Humanos , Masculino , Femenino , Fibrinólisis/efectos de los fármacos , Anciano , Persona de Mediana Edad , Trombosis Intracraneal/metabolismo , Trombosis Intracraneal/tratamiento farmacológico , Accidente Cerebrovascular/metabolismo , Accidente Cerebrovascular/tratamiento farmacológico , Trombectomía/métodos , Activador de Tejido Plasminógeno , Fibrina/metabolismo , Anciano de 80 o más Años , Terapia Trombolítica , Trombosis/metabolismoRESUMEN
INTRODUCTION: The awareness of nonocclusive thrombus has increased with the increasing frequency of imaging methods used for acute ischemic stroke; however, the best treatment for nonocclusive thrombi is still unknown. In this study, we examined how anticoagulants affect supra-aortic artery nonocclusive thrombus and clinical outcomes. MATERIALS AND METHODS: This study included 52 patients with transient ischemic attack or stroke who were diagnosed with nonocclusive thrombi on computed tomography angiography at admission. Patients were treated with anticoagulant treatment and grouped according to treatment modality (either unfractionated heparin or low molecular weight heparin) and treatment duration. Primary safety outcome was major bleeding defined as immediate and clnically significant hemorrhage. Anticoagulant treatment was continued until the thrombus was resolved as determined by consecutive weekly computed tomography angiography controls. After thrombus resolution, treatment was directed according to the underlying etiology. Antiaggregation treatment was the preferred treatment after thrombus resolution for patients with no observed etiology. RESULTS: The affected internal carotid arteries were most frequently located in the cervical segment (48 %). Complete resolution was achieved within 2 weeks in 50 patients (96 %). The involved vasculature included the following: the extracranial carotid artery segments (n = 26, 50 %), intracranial ICA segments (n = 10, 19 %), basilar artery segments (n = 8, 15 %) and MCA segments (n = 7, 13 %). The most common underlying pathologies were atherosclerosis (n = 17), atrial fibrillation (n = 17), undetermined embolic stroke (n = 8), dissection (n = 7), and malignancy (n = 2). No symptomatic intra- or extracranial bleeding complications due to anticoagulant use were observed in any patient during the study period. A good functional outcome (modified Rankin scale score 0-2) was achieved in 49 patients (94 %) at 3 months. There was no significant difference between treatment type and duration in terms of reinfarction (p = 0.97 and p = 0.78, respectively). CONCLUSION: Anticoagulant treatment is safe and effective in symptomatic patients with intracranial or extracranial artery nonocclusive thrombus, regardless of the anticoagulant type, thrombus location and size.
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Anticoagulantes , Ataque Isquémico Transitorio , Humanos , Masculino , Femenino , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversos , Anciano , Ataque Isquémico Transitorio/tratamiento farmacológico , Ataque Isquémico Transitorio/complicaciones , Persona de Mediana Edad , Resultado del Tratamiento , Accidente Cerebrovascular Isquémico/tratamiento farmacológico , Accidente Cerebrovascular Isquémico/complicaciones , Accidente Cerebrovascular Isquémico/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico por imagen , Anciano de 80 o más Años , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/complicaciones , Estudios Retrospectivos , Trombosis/tratamiento farmacológico , Trombosis/diagnóstico por imagen , Heparina/uso terapéuticoAsunto(s)
Anticoagulantes , Trombosis Intracraneal , Trombosis de la Vena , Humanos , Femenino , Trombosis de la Vena/tratamiento farmacológico , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Masculino , Trombosis Intracraneal/tratamiento farmacológico , Persona de Mediana Edad , Administración Oral , Adulto , Anciano , Rivaroxabán/uso terapéutico , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Inhibidores del Factor Xa/uso terapéutico , Inhibidores del Factor Xa/administración & dosificación , Dabigatrán/uso terapéutico , Dabigatrán/administración & dosificaciónAsunto(s)
Púrpura Trombocitopénica Idiopática , Humanos , Púrpura Trombocitopénica Idiopática/tratamiento farmacológico , Púrpura Trombocitopénica Idiopática/complicaciones , Trombosis Intracraneal/tratamiento farmacológico , Enfermedad Crónica , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/diagnóstico por imagen , Niño , Femenino , Masculino , Quimioterapia CombinadaRESUMEN
BACKGROUND: The efficacy and safety of dabigatran etexilate for Chinese patients with cerebral venous thrombosis (CVT) has not been well established. METHODS: CHOICE-CVT was an exploratory, single-center, randomized, open-label study in the National Center for Neurological Disorders involving Chinese patients with CVT aged 18 to 80 years who were randomly assigned (1:1) to either dabigatran etexilate or warfarin. Oral anticoagulants were initiated after 10-15 days of LMWH. The primary efficacy and safety endpoints included the number of patients with recurrent CVT and/or deep venous thrombosis (DVT) and major clinical bleeding within 180 days. Secondary efficacy endpoints included venous recanalization and change in papilledema at day 180. Secondary safety outcomes comprised death, clinical nonmajor bleeding, and any bleeding. The study was registered with ClinicalTrials.gov under NCT03930940. RESULTS: Between October 2017 and February 2023, a total of 89 patients were enrolled and randomly assigned to receive either dabigatran etexilate (n = 44) or warfarin (n = 45). At day 180, the dabigatran etexilate group showed a statistically nonsignificant but likely clinically significant number of patients with recurrent CVT and/or DVT (8 (18.2%; 95% CI, 6.3-30.0) vs 3 (6.7%; 95% CI, 0.0-14.2), p = 0.099, with a power (1-ß) of 38.401%) compared with the warfarin group. The dabigatran etexilate group showed a comparable number of patients with clinical major bleeding (0 (0) vs 0 (0) p = 1.000), and clinical nonmajor bleeding (1 (2.3%; 95% CI, 0.0-6.9) vs 1 (2.2%; 95% CI, 0.0-6.7)) but demonstrated a lower risk of any bleeding (1 (2.3%; 95% CI, 0.0-6.9) vs 9 (20.0%; 95% CI, 7.8-32.2)) compared with the warfarin group. Most patients in both groups achieved venous recanalization according to the Modified Qureshi scale (27 (75%; 95% CI, 60.1-89.9) in the dabigatran etexilate group vs 34 (82.9%; 95% CI, 70.9-95.0) in the warfarin group) and exhibited improvement in papilledema as per the Frisén classification (35 (97.2%; 95% CI, 91.6-100.0) in the dabigatran etexilate group vs 37 (88.1%, 95% CI, 77.9-98.3) in the warfarin group). CONCLUSIONS: These findings regarding efficacy and safety support the consideration of dabigatran etexilate therapy as a viable treatment option for Chinese patients with CVT.
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Anticoagulantes , Dabigatrán , Trombosis Intracraneal , Trombosis de la Vena , Warfarina , Humanos , Dabigatrán/uso terapéutico , Dabigatrán/efectos adversos , Masculino , Femenino , Warfarina/uso terapéutico , Warfarina/efectos adversos , Persona de Mediana Edad , Trombosis de la Vena/tratamiento farmacológico , Adulto , Anticoagulantes/uso terapéutico , Anticoagulantes/efectos adversos , Trombosis Intracraneal/tratamiento farmacológico , Anciano , China/epidemiología , Hemorragia/inducido químicamente , Antitrombinas/uso terapéutico , Antitrombinas/efectos adversos , Adulto Joven , Adolescente , Resultado del Tratamiento , Anciano de 80 o más Años , Pueblos del Este de AsiaRESUMEN
OBJECTIVES: To assess outcomes and complications of patients with cerebral venous thrombosis (CVT). METHODS: This multicenter retrospective study was conducted at 2 health care centers in Saudi Arabia and Oman. Adult patients diagnosed with CVT in radiological imaging between 2006 and 2020 were included. Data were collected from medical records and analyzed using the software IBM® SPSS version 22. Neurological disability occurring after CVT was graded according to the modified Rankin scale (mRS). RESULTS: The study included 103 patients, of which the majority (68%) were female. The mean age was 39.12±12.96 years. Two-thirds of patients received low-molecular-weight heparin (LMWH) in acute treatment, while 76% of discharged patients used warfarin. The majority of patients had no or mild neurological disability during follow-up, and 6 patients had an mRS score ≥3, implying significant neurological disability. There were 55 patients (52.3%) who had complications from CVT, including seizures in 17 (16.5%) patients and one mortality. Follow-up imaging of 55 patients showed complete thrombus resolution in 20 patients (36%). CONCLUSION: Anticoagulation is the mainstay treatment for CVT patients. Approximately half of patients experience complications. Prospective studies are needed to assess the long-term neurological outcomes in such patients.
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Trombosis Intracraneal , Trombosis de la Vena , Adulto , Humanos , Femenino , Masculino , Persona de Mediana Edad , Heparina de Bajo-Peso-Molecular , Estudios Retrospectivos , Trombosis Intracraneal/complicaciones , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/tratamiento farmacológico , Omán , Trombosis de la Vena/complicaciones , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon cause of stroke that mainly affects young adults. Early, accurate diagnosis can reduce the rate and severity of complications. OBJECTIVE: The aim of this study was to analyse the clinical characteristics, management, and treatment of CVT in different centres in Spain. METHODS: We conducted a multicentre, retrospective, descriptive study of patients hospitalised due to CVT between 2008 and 2017 at 10 Spanish centres. RESULTS: We included 256 patients, with a mean age (SD) of 49.8 (18.7) years; 51% of patients were women. The most frequent symptoms were headache (73%), focal deficits (50%), epileptic seizures (33%), and encephalopathy (21%). The most frequent localisations were the superior sagittal sinus (12.5%), the transverse sinus (10.9%), and 2 or more sinuses or veins (66.4%). Thrombophilia was the most frequent known aetiology (24%), and was most commonly associated with the prothrombin G20210A mutation (19%). Forty-six percent of patients were treated with antithrombotics for 3 to 6 months, 21% for one year, and 22.6% required indefinite anticoagulation. Endovascular therapy was performed in 5% of cases, and 33% required neurosurgery. Regarding outcomes, 75% of patients were independent at 3 months (modified Rankin Scale [mRS] score ≤ 2), with papilloedema (Pâ¯=⯠.03), focal deficits (Pâ¯=â¯.001), and encephalopathy (Pâ¯<â¯.001) showing a statistically significant association with poor prognosis (mRS > 3). The in-hospital mortality rate was 4.3%, with a 3-month mortality rate of 6.3%. CONCLUSION: The diverse risk factors and variable presentation of CVT represent a challenge in the diagnosis and treatment of this condition. To improve prognosis and reduce mortality, it is essential to establish management protocols for this entity.
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Trombosis Intracraneal , Accidente Cerebrovascular , Trombosis de la Vena , Adulto Joven , Humanos , Femenino , Persona de Mediana Edad , Masculino , Estudios Retrospectivos , España , Trombosis de la Vena/terapia , Trombosis de la Vena/tratamiento farmacológico , Trombosis Intracraneal/terapia , Trombosis Intracraneal/tratamiento farmacológicoRESUMEN
The evolution of the Coronavirus Disease-2019 pandemic and its vaccination raised more attention to cerebral venous thrombosis (CVT). Although CVT is less prevalent than arterial stroke, it results in larger years of life lost. CVT is more common in women and young patients. Predisposing factors are categorized as transient factors such as pregnancy, puerperium, oral contraceptive pills, trauma, and dehydration; and permanent factors such as neoplastic, vasculitic, thrombophilic, hematologic conditions, infectious causes such as severe acute respiratory syndrome coronavirus-2 infection and HIV. The most common manifestations are headache, seizures, focal neurologic deficits, altered level of consciousness, and cranial nerve palsies. The most common syndromes are stroke-like, raised-intracranial-pressure (ICP), isolated-headache, and encephalopathy, which may have overlaps. Diagnosis is mostly based on computed tomography, magnetic resonance imaging, and their respective venous sequences, supported by blood results abnormalities such as D-dimer elevation. Treatment includes the prevention of propagation of current thrombus with anticoagulation (heparin, or low molecular weight heparinoids and then warfarin, or direct oral anticoagulants), decreasing ICP (even by decompressive craniotomy), and treatment of specific underlying diseases.
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Trombosis Intracraneal , Accidente Cerebrovascular , Trombosis de la Vena , Embarazo , Humanos , Femenino , Anticoagulantes/uso terapéutico , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/tratamiento farmacológico , Cefalea/complicaciones , Accidente Cerebrovascular/complicacionesRESUMEN
Cerebral venous thrombosis is a rare cause of stroke in young mostly female adults which is frequently overlooked due to its variable clinical and radiological presentation. This review summarizes current knowledge on it risk factors, management and outcome in adults and highlights areas for future research. Females are 3 times more commonly affected and are significantly younger than males. The presenting symptoms can range from headache to loss of consciousness. However, the often-nebulous nature of symptoms can make the diagnosis challenging. Magnetic resonance imaging with venography is often the diagnostic imaging of choice. While unfractionated or low molecular-weight heparin is the mainstay of treatment, endovascular intervention with thrombolysis or thrombectomy and decompressive craniectomy may be required depending on clinical status. Nevertheless, approximately 80% of patients have a good recovery but mortality rates of -5% to 10% are not uncommon. Diagnosing cerebral venous thrombosis can be challenging but with vigilance and expert care patients have the best chance of a good clinical outcome.
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Trombosis Intracraneal , Trombosis de los Senos Intracraneales , Trombosis de la Vena , Masculino , Adulto , Humanos , Femenino , Trombosis Intracraneal/terapia , Trombosis Intracraneal/tratamiento farmacológico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Imagen por Resonancia Magnética , Senos Craneales , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/terapia , Trombosis de la Vena/patología , Trombosis de los Senos Intracraneales/terapia , Trombosis de los Senos Intracraneales/tratamiento farmacológicoRESUMEN
OBJECTIVE: Cerebral venous thrombosis (CVT) is a rare condition whose clinical presentation can range from simple headaches to severe impairment of alertness. Some clinical forms, such as involvement of the deep venous system, are associated with a poorer clinical prognosis despite well-managed anticoagulation. The role and timing of rescue mechanical thrombectomy for these patients is not well established. METHOD: Clinical and imaging follow-up are discussed according to our treatment decision. RESULTS: We describe two cases with deep venous system thrombosis that were treated unsuccessfully with optimal anticoagulation, with a spectacular clinical and radiological response after mechanical thrombectomy (MT). CONCLUSION: These cases demonstrate that, despite the negative results of the TO-ACT trial, MT could be considered as a rescue treatment in some clinical forms of deteriorating CVT despite optimal anticoagulation.
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Trombosis Intracraneal , Trombosis , Trombosis de la Vena , Humanos , Anticoagulantes/uso terapéutico , Trombectomía/métodos , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/tratamiento farmacológico , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico , Trombosis/complicacionesRESUMEN
Objetivos Describir las características basales, de presentación clínica, de imagen y evolución e identificar potenciales factores pronósticos en una cohorte de pacientes con trombosis venosa cerebral (TVC). Pacientes y métodos Estudio observacional retrospectivo, unicéntrico, que incluye a pacientes adultos con diagnóstico de TVC desde enero 2016 hasta diciembre 2020. Las variables fueron recogidas a través de la historia clínica electrónica. Resultados Se incluyeron 35 pacientes con una edad media al diagnóstico de 50,3 (±17,8) años, siendo la mayoría mujeres (74,4%). El 95% de los pacientes presentaba al menos un factor de riesgo para el desarrollo de TVC. El 97,1% recibió tratamiento anticoagulante con heparinas en la fase aguda, en su mayoría heparina de bajo peso molecular (75%). El evento compuesto (muerte, ingreso en unidad de cuidados intensivos, National institute of Health Stroke Scale al alta >3, recurrencia de TVC, hemorragia mayor, o la presencia de complicaciones) en las primeras dos semanas ocurrió en el 28,6%. El seguimiento medio fue de 3,3 años, durante el cual el 14,3% falleció (solo un paciente en relación con la TVC), un paciente presentó hemorragia mayor y ningún paciente presentó recurrencia de TVC. Conclusiones En nuestra cohorte, la TVC afectó con mayor frecuencia a mujeres jóvenes, y ocurrió en pacientes con al menos un factor de riesgo para TVC. La presencia de edema en la tomografía computarizada y el tratamiento con corticosteroides asociaron un peor pronóstico a corto plazo. Se observó un buen pronóstico a largo plazo en términos de mortalidad, recurrencia y sangrado (AU)
Objective To describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). Patients and methods This retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. Results A total of 35 patients were included, with a median age at diagnosis of 50.3 (± 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins. During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients). Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. Conclusions In our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding (AU)
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Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Trombosis Intracraneal/diagnóstico , Trombosis de la Vena/diagnóstico , Estudios Retrospectivos , Estudios de Seguimiento , Recurrencia , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/etiología , Factores de Riesgo , PronósticoRESUMEN
OBJECTIVE: To describe the baseline characteristics, clinical presentation, imaging tests and outcomes, and identify potential prognostic factors in a cohort of patients diagnosed with cerebral venous thrombosis (CVT). PATIENTS AND METHODS: This retrospective, single-center, observational study included adult patients diagnosed with CVT from January 2016 to December 2020. The variables were reviewed using electronic medical records. RESULTS: A total of 35 patients were included, with a median age at diagnosis of 50.3 (+/- 17.8) years, and the majority being women (74.4%). Nearly 95% of the patients presented at least one risk factor for the development of CVT. Heparins were used for the acute phase in 97.1% of cases, with 75% of those being low molecular weight heparins.During the first two weeks, a compound event (death, intensive care unit admission, National Institute of Health Stroke Scale at discharge >3, CVT recurrence, major bleeding, or the presence of complications) occurred in 28.6% of patients (10 patients).Over the mean follow-up period of 3.3 years, 14.3% of the patients died (with only one death attributed to CVT), one patient experienced major bleeding, and no patients had a recurrence of CVT. CONCLUSIONS: In our cohort, CVT predominantly affected young women with at least one risk factor for its development. The presence of edema on CT and corticosteroid treatment were associated with a poor short-term prognosis. However, we observed a favorable long-term prognosis in terms of mortality, recurrence, and bleeding.
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Trombosis Intracraneal , Trombosis de la Vena , Adulto , Humanos , Femenino , Masculino , Estudios Retrospectivos , Centros de Atención Terciaria , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/etiología , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/etiología , Pronóstico , Factores de RiesgoRESUMEN
RATIONALE: Multiple sclerosis (MS) is a central nervous system disease mainly mediated by immunity, which is one of the most common causes of neurological dysfunction in young people worldwide. In the acute phase, high-dose steroid therapy is effective. There are few reports about cerebral venous thrombosis (CVT) after high-dose steroid therapy. PATIENT CONCERNS: We present a case of a 19-year-old female diagnosed with MS who developed a headache after high-dose steroid therapy was diagnosed with CVT. Headache symptoms improved after anticoagulant treatment. DIAGNOSES: MS comorbid CVT. INTERVENTIONS: Anticoagulant therapy was added and hormone therapy was reduced. OUTCOMES: Clinical symptoms such as headache, limb numbness, and involuntary tremors in the right hand were improved, and the muscle strength of the right limb recovered to grade 4. The patient did not suffer from headaches after discharge and no abnormality in the computed tomography (CT) scan of the cephalic vein at the 5-months follow-up. LESSONS: High-dose steroid therapy may be a risk factor for CVT in patients with MS. MS patients who develop headaches during high-dose steroid therapy should undergo further cranial CTV to rule out CVT.
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Trombosis Intracraneal , Esclerosis Múltiple , Trombosis de la Vena , Femenino , Humanos , Adolescente , Adulto Joven , Adulto , Esclerosis Múltiple/complicaciones , Esclerosis Múltiple/tratamiento farmacológico , Trombosis de la Vena/inducido químicamente , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/diagnóstico , Trombosis Intracraneal/inducido químicamente , Trombosis Intracraneal/diagnóstico por imagen , Trombosis Intracraneal/tratamiento farmacológico , Cefalea/etiología , Esteroides/uso terapéutico , Anticoagulantes/efectos adversosRESUMEN
OBJECTIVE: Cerebral venous thrombosis (CVT), thrombosis of the dural sinus, cerebral veins, or both, is a rare cerebrovascular disease. Although mortality rates after CVT have declined over time, this condition can result in devastating neurologic outcomes. This article reviews the latest literature regarding CVT epidemiology, details new factors associated with the development of CVT, and describes advances in CVT treatment. It also contains a discussion of future directions in the field, including novel diagnostic imaging modalities, and potential strategies to reduce the risks associated with CVT. LATEST DEVELOPMENTS: The incidence of CVT may be as high as 2 per 100,000 adults per year. It remains a difficult condition to diagnose given its variable clinical manifestations and the necessity of neuroimaging for confirmation. The COVID-19 pandemic has revealed a novel CVT trigger, vaccine-induced immune thrombotic thrombocytopenia (VITT), as well as an association between COVID-19 infection and CVT. Although VITT is a very rare event, timely diagnosis and treatment of CVT due to VITT likely improves patient outcomes. Direct oral anticoagulants are currently being used to treat CVT and emerging data suggest that these agents are as safe and effective as vitamin K antagonists. The role of endovascular therapy to treat CVT, despite a recent clinical trial, remains unproven. ESSENTIAL POINTS: The incidence of CVT has increased, outcomes have improved, and the use of direct oral anticoagulants to treat CVT represents an important advance in the clinical care of these patients. Rates of CVT as a complication of COVID-19 vaccines using adenoviral vectors are very low (<5 per million vaccine doses administered), with the benefits of COVID-19 vaccination far outweighing the risks.
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Vacunas contra la COVID-19 , COVID-19 , Trombosis Intracraneal , Trombosis de la Vena , Adulto , Humanos , Anticoagulantes/uso terapéutico , COVID-19/complicaciones , COVID-19/prevención & control , Prueba de COVID-19 , Vacunas contra la COVID-19/efectos adversos , Trombosis Intracraneal/diagnóstico , Trombosis Intracraneal/tratamiento farmacológico , Pandemias , Trombosis de la Vena/terapia , Trombosis de la Vena/tratamiento farmacológicoRESUMEN
BACKGROUND: Prothrombotic and pro-inflammatory states are known cerebral venous thrombosis risk factors. To date, two cases of venous thrombotic events after immunoglobulin-E mediated anaphylaxis have been reported. Herein, we describe the first case of cerebral venous thrombosis in close temporal relation with an immunoglobulin-E mediated anaphylactic event. CASE DESCRIPTION: A 51-year-old female presented with headache, language, and mental disturbance lasting for two days. Two days before the onset, she had undergone a provocative test with deflazacort to study an allergy history; after the test she developed a severe anaphylactic reaction. There were no other comorbidities, and in addition to contraceptive pill, she did not take other medications. On admission the patient was drowsy, with anomic aphasia, inattention and memory impairment. Magnetic Resonance Imaging depicted a left caudate and lenticulo-capsulo-thalamic venous infarct and thrombosis in the deep venous system. The patient was treated with anticoagulation and showed progressive improvement. Neoplastic and pro-thrombotic diseases were excluded. CONCLUSION: The close temporal association between the anaphylactic reaction and cerebral venous thrombosis suggests that anaphylactic reaction could have been a cerebral venous thrombosis precipitating factor. Immunoglobulin-E have been suggested to have prothrombotic activity by stimulating the release of platelet activation factor, thromboxane A2 and serotonin. This case adds on to the available information on possible cerebral venous thrombosis associated conditions.