Controversies of Treatment Modalities for Cerebral Venous ThrombosisReport as inadecuate




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Stroke Research and TreatmentVolume 2010 2010, Article ID 956302, 7 pages

Review ArticleDepartment of Medicine Neurology, Aga Khan University, Stadium Road, Karachi 74800, Pakistan

Received 13 August 2010; Revised 15 October 2010; Accepted 8 November 2010

Academic Editor: Chelsea S. Kidwell

Copyright © 2010 Maria Khan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cerebral vein thrombosis has been well recognized for nearly two centuries. However,therapeutic options for the condition are limited due to lack of large randomized trials. Thevarious modalities reportedly used include antiplatelets, anticoagulation, fibrinolysis, andmechanical thrombectomy. Of these, antiplatelets are the least studied, and there are onlyanecdotal reports of aspirin use. Anticoagulation is the most widely used and accepted modalitywith favorable outcomes documented in two randomized controlled trials. Various fibrinolyticagents have also been tried. Local infusions have shown more promise compared to systemicagents. Similarly, mechanical thrombectomy has been used to augment the effects of chemicalthrombolysis. However, in the absence of randomized controlled trials; there is no concreteevidence of the safety and efficacy of either of these modalities. Limited study series disclosedthat decompression surgery in malignant CVT can be life saving and provides good neurologicaloutcome in some cases. Conclusion. Overall therapeutics for CVT need larger randomizedcontrolled trials. Anticoagulaion with heparin is the only modality with a reasonable evidence tosupport its use in CVT. Endovascular thrombolysis and mechanical thrombectomy are reservedfor selected cases who fail anticoagulation and decompression surgery for malignant CVT withimpending herniation.





Author: Maria Khan, Ayeesha Kamran Kamal, and Mohammad Wasay

Source: https://www.hindawi.com/



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