Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection–Associated Cerebral Venous Thrombosis

Abstract

Background and Purpose-Local infections of the head or neck are a cause of cerebral venous thrombosis. Treatment of infectious cerebral venous thrombosis with heparin is controversial. We examined whether this treatment was associated with intracranial hemorrhagic complications and poor clinical outcome. Methods-We retrieved data from a prospective cohort study of 624 cerebral venous thrombosis patients. We compared patients with and without an infection of the head or neck and anticoagulated versus not anticoagulated. We examined death or dependency and new intracerebral hemorrhages. Results-Six hundred four of 624 patients were eligible for the study. Fifty-seven patients had an infection of the head or neck (9.4%). Comparing data between infection and noninfection patients, the frequency of therapeutic doses of heparin was similar in both groups (82.5% versus 83.7%). New intracerebral hemorrhages were more common in patients with an infection (12.3% versus 5.3%; P=0.04), but death or dependency did not differ between patients with and without an infection (15.8% versus 13.7%). In patients with an infection of the head or neck, there was no significant difference in the frequency of new intracerebral hemorrhages and poor outcome between patients who did or did not receive therapeutic doses of heparin. Conclusions-New intracerebral hemorrhages were more frequent in patients with an infection. The use of therapeutic doses of heparin did not seem to influence the risk of new intracranial hemorrhages or poor clinical outcome, but the number of patients who did not receive anticoagulation was too small to draw firm conclusions about safety of heparin in adults with cerebral venous thrombosis and an infection of the head or neck.

Cavernous sinus thrombosis due to ipsilateral sphenoid sinusitis

“…A Cochrane meta-analysis12 (including only two small RCT of CS thrombosis irrespective of aetiology) concluded that anticoagulation is safe and may improve outcome, but the average time to the initiation of anticoagulation was 4 weeks and 10 days, respectively. A recent analysis of the subgroup of patients with septic CS thrombosis13 included in the largest prospective cohort study on adult CS thrombosis showed that the vast majority received anticoagulation ‘in the acute phase’ but the clinical outcome did not differ as compared with the patients who did not. Also, all patients with a new intracerebral haemorrhage were treated with anticoagulation.…”

“…In our patient fatal SAH and intraventricular haemorrhage occurred 24 hours after the initiation of anticoagulation. SAH seems to be exclusively a complication of the anticoagulation treatment, although there are rare case reports of SAH as presenting sign of aseptic CST 13. Retrospectively, taking into consideration the age of the patient, the significant delay in establishing the diagnosis of septic CST, the previous use of antiplatelet agents and the scheduled operation, the haemorrhagic risk was high and the initiation of anticoagulation should have been deferred.…”

Prognosis of septic cavernous sinus thrombosis remarkably improved: a case series of 12 patients and literature review

“…Although there are differences between these entities, there is considerable overlap in pathophysiology. We, therefore, use data on cerebral venous thrombosis in our considerations for the treatment of CST, as suggested by Desa et al [ 27 ] In patients with meningitis, we usually refrain from anticoagulation, given the increased risk of intracerebral bleeding [ 28 ]. The decision whether or not to start with AT is preceded by consultation with a neurologist in every case.…”

Cerebral Venous Thrombosis: A Clinical Overview

“…Analysis of the ISCVT cohort revealed that new ICH was more frequent in patients with infection as the etiology of their CVT [116]. The study compared infected versus noninfected Cerebral Venous Thrombosis: A Clinical Overview http://dx.doi.org/10.5772/intechopen.79049 patients, with infected patients representing 9.4% of the cohort.…”