Abstract 3689: Safety And Efficacy Of Anticoagulation In Patients With Cerebral Venous Sinus Thrombosis Presenting With Subarachnoid Hemorrhage.

Abstract

Objective: Conventional treatment of cerebral venous sinus thrombosis (CVST) has been systemic heparinization. A small percentage of CVST present with subarachnoid hemorrhage (SAH). We retrospectively evaluated the efficacy and safety of anticoagulation in consecutive patients with SAH due to CSVT. Materials and Methods: A retrospective review of our stroke database from November, 1994 to August, 2010 identified 21 consecutive patients who had presented with SAH secondary to CVST. CVST was documented through angiography, venous angioTC or venous phase angioresonance. CVST was documented through CT scan or lumbar puncture when image was equivocal. Diagnosis was performed by a neurologist and confirmed by neuorradiologists. Patient histories were reviewed to collect data on presentation, presence of venous infarction or hemorrhagic transformation, affected sinus, treatment with anticoagulation, follow up, and functional outcome. Results: 21 patients were included for analysis. The mean patient age was 39years (20-83). Sixty-seven percent of patients were female. The initial symptom was thunderclap headache in 11 patients (52%), acute progressive headache in 9 patients (43%) and seizures in 1 patient (5%). 15 patients (71.4%) were treated with anticoagulants. 10 patients (48%) were treated with low molecular weight heparin, 5 patients (24%) with non fractioned heparin. All these patients continued treatment with oral anticoagulation. 3 patients (14.3% received treatment with antiplatelet agents. 3 patients (14%) received no treatment. No patients developed intracaranial or extracranial hemorrhagic complications after initial treatment. One patient died due to cerebral edema. All other patients had good functional outcome (modified Rankin Scale<2) regardless of treatment. Conclusion: Treatment with anticoagulant drug appear to be safe in the setting of CVST related HSA. Outcome appears to be good in most patients. Our study is not powered to detect the efficacy of treatment in these patients.