Characteristics and outcomes of postpartum cerebral venous sinus thrombosis: A subgroup analysis of the ACTION-CVT study

Fang, Ton; Shu, Liqi; Elnazeir, Marwa; Zubair, Adeel S.; Kasab, Sami Al; Antonenko, Kateryna; Heldner, Mirjam R; Yaghi, Shadi; Henninger, Nils

doi:10.1016/j.jstrokecerebrovasdis.2022.106865

Cited by 4 publications

(5 citation statements)

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“…24 Due to changes in the internal environment of the human body before and after pregnancy, the risk of CVST increases during pregnancy and puerperium, and most of them occur in early pregnancy and 1 to 4 weeks after delivery. 25 Studies have found that patients with onset in early pregnancy are more susceptible to abnormal blood coagulation. 26 The increase of estrogen level and the increase of procoagulants such as von Willebrand factor, fibrinogen, and blood coagulation factors (I, VII, VIII, IX, X, and XII) make the blood hypercoagulable state.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Values of Coagulation Factors X, XI, and XII in Cerebral Venous Sinus Thrombosis During Perinatal State

Li,

Duan,

et al. 2023

Clin Appl Thromb Hemost

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Cerebral venous sinus thrombosis (CVST) has become a rare but potentially life-threatening condition in perinatal women. Early and rapid identification of CVST in pregnant women is a challenge for frontline clinical workers. In this study, 40 perinatal patients with CVST in our hospital were included in the five-year period, and 120 normal perinatal pregnant women in the obstetrics and gynecology department of our hospital were randomly enrolled in the five-year period as the control group, including 60 cases in pregnancy and puerperium. 5 mL of fasting venous blood was collected from puerperal CVST patients in the acute phase of onset (within 72 h of onset) and the recovery phase (fourth week of treatment). In the control group, 5 mL of fasting venous blood was collected. Coagulation factors X, XI, and XII, plasma D-Dimer were analyzed and compared. Coagulation factors X, XI, and XII in plasma of CVST patients were significantly increased compared with controls. Plasma coagulation factors X, XI, and XII and their combined detection (Union Model = 0.056 * FX: C + 0.046 * FXI: C + 0.081 * FXII: C) have diagnostic values for perinatal CVST. Plasma coagulation factors X, XI, and XII were significantly positively correlated with plasma D-dimer levels in perinatal CVST patients. Plasma coagulation factors X, XI, and XII have diagnostic values for perinatal CVST.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Values of Coagulation Factors X, XI, and XII in Cerebral Venous Sinus Thrombosis During Perinatal State

Li,

Duan,

et al. 2023

Clin Appl Thromb Hemost

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“…Therefore, anticoagulation for CVT during pregnancy and early in the puerperium consists of LMWH in the majority of women. 12,72,73 There is limited evidence on endovascular therapies in this population. As in nonpregnant women, thrombolysis and thrombectomy are reserved for patients with neurological deterioration or propagation of the thrombus despite medical therapy (Figure 4).…”

Section: Cvt In Special Populationsmentioning

confidence: 99%

“…74 According to the available evidence, CVT is not a contraindication for future pregnancies. 12,72,75 Considering the additional risk that pregnancy confers to women with a history of CVT, prophylaxis with LMWH during future pregnancies and the postpartum period is probably beneficial. 75…”

Section: Future Pregnancies and Recurrencementioning

confidence: 99%

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association

Saposnik,

Bushnell,

Coutinho

et al. 2024

Stroke

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Cerebral venous thrombosis accounts for 0.5% to 3% of all strokes. The most vulnerable populations include young individuals, women of reproductive age, and patients with a prothrombotic state. The clinical presentation of cerebral venous thrombosis is diverse (eg, headaches, seizures), requiring a high level of clinical suspicion. Its diagnosis is based primarily on magnetic resonance imaging/magnetic resonance venography or computed tomography/computed tomographic venography. The clinical course of cerebral venous thrombosis may be difficult to predict. Death or dependence occurs in 10% to 15% of patients despite intensive medical treatment. This scientific statement provides an update of the 2011 American Heart Association scientific statement for the diagnosis and management of cerebral venous thrombosis. Our focus is on advances in the diagnosis and management decisions of patients with suspected cerebral venous thrombosis. We discuss evidence for the use of anticoagulation and endovascular therapies and considerations for craniectomy. We also provide an algorithm to optimize the management of patients with cerebral venous thrombosis and those with progressive neurological deterioration or thrombus propagation despite maximal medical therapy.

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“… 5 We further hypothesized that well‐known CVT risk factors, including oral contraceptive use, cancer, and postpartum state, would be associated with a lack of delay in CVT diagnosis. 1 , 7 , 8 An improved understanding of factors associated with diagnostic delay among patients with CVT is a key component of future interventions to improve diagnostic accuracy to impact clinical outcomes.…”

mentioning

confidence: 99%

Delayed Diagnosis in Cerebral Venous Thrombosis: Associated Factors and Clinical Outcomes

Bakradze,

Shu,

Henninger

et al. 2023

JAHA

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Background Identifying factors associated with delayed diagnosis of cerebral venous thrombosis (CVT) can inform future strategies for early detection. Methods and Results We conducted a retrospective cohort study including all participants from ACTION‐CVT (Anticoagulation in the Treatment of Cerebral Venous Thrombosis) study who had dates of neurologic symptom onset and CVT diagnosis available. Delayed diagnosis was defined as CVT diagnosis occurring in the fourth (final) quartile of days from symptom onset. The primary study outcome was modified Rankin Scale score of ≤1 at 90 days; secondary outcomes included partial/complete CVT recanalization on last available imaging and modified Rankin Scale score of ≤2. Logistic regression analyses were used to identify independent variables associated with delayed diagnosis and to assess the association of delayed diagnosis and outcomes. A total of 935 patients were included in our study. Median time from symptom onset to diagnosis was 4 days (interquartile range, 1–10 days). Delayed CVT diagnosis (time to diagnosis >10 days) occurred in 212 patients (23%). Isolated headache (adjusted odds ratio [aOR], 2.36 [95% CI, 1.50–3.73]; P <0.001), older age (aOR by 1 year, 1.02 [95% CI, 1.004–1.03]; P =0.01), and papilledema (aOR, 2.00 [95% CI, 1.03–3.89]; P =0.04) were associated with diagnostic delay, whereas higher National Institutes of Health Stroke Scale score was inversely associated with diagnostic delay (aOR by 1 point, 0.95 [95% CI, 0.89–1.00]; P =0.049). Delayed diagnosis was not associated with modified Rankin Scale score of ≤1 at 90 days (aOR, 1.08 [95% CI, 0.60–1.96]; P =0.79). Conclusions In a large multicenter cohort, a quarter of included patients with CVT were diagnosed >10 days after symptom onset. Delayed CVT diagnosis was associated with the symptom of isolated headache and was not associated with adverse clinical outcomes.

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Characteristics and outcomes of postpartum cerebral venous sinus thrombosis: A subgroup analysis of the ACTION-CVT study

Cited by 4 publications

References 21 publications

Clinical Values of Coagulation Factors X, XI, and XII in Cerebral Venous Sinus Thrombosis During Perinatal State

Clinical Values of Coagulation Factors X, XI, and XII in Cerebral Venous Sinus Thrombosis During Perinatal State

Diagnosis and Management of Cerebral Venous Thrombosis: A Scientific Statement From the American Heart Association

Delayed Diagnosis in Cerebral Venous Thrombosis: Associated Factors and Clinical Outcomes

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