Cerebral Venous Thrombosis: an Update

Ferro, José M.; Sousa, Diana Aguiar de

doi:10.1007/s11910-019-0988-x

Cited by 139 publications

(134 citation statements)

References 74 publications

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“…CT venography can confirm CVT diagnosis by showing the intraluminal filling defects, and has high sensitivity for both dural venous sinus thrombosis (99%) and cerebral vein thrombosis (88%) [1]. CT venography is usually widely available; however, some anatomic variants (such as sinus hypoplasia or atresia) can be misclassified as sinus thrombosis, whereas cortical vein thrombosis can remain undetected by CT venography alone [22]. MR is nowadays the reference standard imaging for CVT, especially when performed as contrast-enhanced MR venography [22].…”

Section: Diagnosismentioning

confidence: 99%

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Riva

Ageno

2020

JCM

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Cerebral vein thrombosis (CVT) and splanchnic vein thrombosis (SVT) are two manifestations of venous thromboembolism (VTE) at unusual sites. They have an incidence at least 25–50 times lower than usual site VTE, but represent true clinical challenges. Recent evidence on the epidemiology, risk factors, prognosis, and treatment of CVT and SVT has been published in the last two decades, thus contributing to a better understanding of these diseases. The improvement in imaging techniques and a higher degree of clinical suspicion may have led to the observed increased frequency, whereas a better knowledge of provoking mechanisms could have contributed to reducing the proportion of events classified as unprovoked or idiopathic (13–21% of CVT, 15–27% of SVT). Few small randomized clinical trials and a number of observational studies, although hampered by heterogeneous therapeutic approaches, shed light on the safety and effectiveness of anticoagulant therapy in these populations. However, there are still some grey areas that warrant future research. In this narrative review, we discuss recent advances and therapeutic challenges in CVT and SVT.

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Section: Diagnosismentioning

confidence: 99%

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Riva

Ageno

2020

JCM

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“…Em caso de suspeita de TVC, alguns exames laboratoriais são relevantes como hemograma, coagulograma, provas inflamatórias e D-dímero (Neto;Takayanagui, 2013). Já a confirmação do diagnóstico necessita da visualização de trombos nas veias e seios cerebrais em (Ferro;Canhão, 2014).…”

Section: Resultsunclassified

“…A Trombose Venosa Cerebral (TVC) é uma obstrução intracraniana de veias e de seios, sendo um tipo incomum de afecção cerebrovascular que afeta aproximadamente 5 a cada 1.000.000 de pessoas mundialmente (Bousser;Ferro, 2007). Tal doença pode ocorrer em qualquer faixa etária, até mesmo em recém-nascidos, com pico de incidência nos adultos jovens entre 30 a 40 anos de idade, sendo três vezes mais comum em mulheres do que em homens.…”

Section: Introductionunclassified

“…A TVC vem sendo diagnosticada com maior frequência devido ao aumento da realização de ressonância magnética (RM) nos casos de investigação de cefaleia e epilepsia. A confirmação diagnóstica é dada pela RM em combinação com venografia por RM ou VenoTC (Ferro;Canhão, 2014).…”

Section: Introductionunclassified

“…O tratamento da TVC é baseado no uso de antitrombóticos, fármacos para alívio dos sintomas e resolução da causa base (Ferro;Canhão, 2014).…”

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Trombose Venosa Cerebral: Aspectos Gerais e Métodos Diagnósticos

Balieiro

Lima

Tartuce

et al. 2020

BJHR

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Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine–Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis

et al. 2021

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IMPORTANCEThe COVID-19 pandemic saw one of the fastest developments of vaccines in an effort to combat an out-of-control pandemic. The 2 most common COVID-19 vaccine platforms currently in use, messenger RNA (mRNA) and adenovirus vector, were developed on the basis of previous research in use of this technology. Postauthorization surveillance of COVID-19 vaccines has identified safety signals, including unusual cases of thrombocytopenia with thrombosis reported in recipients of adenoviral vector vaccines. One of the devastating manifestations of this syndrome, termed vaccine-induced immune thrombotic thrombocytopenia (VITT), is cerebral venous sinus thrombosis (CVST). This review summarizes the current evidence and indications regarding biology, clinical characteristics, and pharmacological management of VITT with CVST.OBSERVATIONS VITT appears to be similar to heparin-induced thrombocytopenia (HIT), with both disorders associated with thrombocytopenia, thrombosis, and presence of autoantibodies to platelet factor 4 (PF4). Unlike VITT, HIT is triggered by recent exposure to heparin. Owing to similarities between these 2 conditions and lack of high-quality evidence, interim recommendations suggest avoiding heparin and heparin analogues in patients with VITT. Based on initial reports, female sex and age younger than 60 years were identified as possible risk factors for VITT. Treatment consists of therapeutic anticoagulation with nonheparin anticoagulants and prevention of formation of autoantibody-PF4 complexes, the latter being achieved by administration of high-dose intravenous immunoglobin (IVIG). Steroids, which can theoretically inhibit the production of new antibodies, have been used in combination with IVIG. In severe cases, plasma exchange should be used for clearing autoantibodies. Monoclonal antibodies, such as rituximab and eculizumab, can be considered when other therapies fail. Routine platelet transfusions, aspirin, and warfarin should be avoided because of the possibility of worsening thrombosis and magnifying bleeding risk.CONCLUSIONS AND RELEVANCE Adverse events like VITT, while uncommon, have been described despite vaccination remaining the most essential component in the fight against the COVID-19 pandemic. While it seems logical to consider the use of types of vaccines (eg, mRNA-based administration) in individuals at high risk, treatment should consist of therapeutic anticoagulation mostly with nonheparin products and IVIG.

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Cerebral Venous Thrombosis: an Update

Cited by 139 publications

References 74 publications

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Trombose Venosa Cerebral: Aspectos Gerais e Métodos Diagnósticos

Clinical Characteristics and Pharmacological Management of COVID-19 Vaccine–Induced Immune Thrombotic Thrombocytopenia With Cerebral Venous Sinus Thrombosis

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