The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis

Afshari, Daryoush; Moradian, Nasrin; Nasiri, Freshteh; Razazian, Nazanin; Bostani, Arash; Sariaslani, Payam

doi:10.17712/nsj.2015.4.20150375

Cited by 29 publications

(12 citation statements)

References 16 publications

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“…74 abstracts were screened, with 5 papers were read in full text. Three papers were suitable for analysis published between 2010 and 2015 [7], [8], [9]; 1 prospective cohort study and two randomized controlled trials (see Fig. 1 for the search strategy protocol) .…”

Section: Resultsmentioning

confidence: 99%

Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: A systematic review and meta-analysis

Qureshi

Perera

2017

Annals of Medicine &Amp; Surgery

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IntroductionThere are two main choices of anti-coagulation in cerebral venous thrombosis: Unfractionated heparin versus low molecular weight heparin. A consensus is yet to be reached regarding which agent is optimal. Therefore the aim of this systematic review and meta-analysis was to identify which agent is most effective in treating CVT.MethodsDatabases Pubmed (MEDLINE), Google Scholar and hand-picked references from papers of interest were reviewed. Studies comparing the use of low molecular weight heparin and unfractionated heparin in adult patients with a confirmed diagnosis of cerebral vein thrombosis were selected. Data was recorded for patient mortality, functional outcome and haemorrhagic complications of therapy.ResultsA total of 2761 papers were identified, 74 abstracts were screened, with 5 papers being read in full text and three studies suitable for final inclusion. A total of 179 patients were in the LMWH group and 352 patients were in the UH group. Mortality and functional outcome trended towards favouring LMWH with OR [95% CI] of 0.51 [0.23, 1.10], p = 0.09 and 0.79 [0.49, 1.26] p = 0.32 respectively. There was no difference in extra-cranial haemorrhage rates between either agent with a OR [95% CI] of 1.00 [0.29, 3.52] p = 0.99.ConclusionTrends towards improved mortality and improved functional outcomes were seen in patients treated with LMWH. No result reached statistical significance due to low numbers of studies available for inclusion. There is a need for further large scale randomized trials to definitively investigate the potential benefits of LMWH in the treatment of CVT.

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Section: Resultsmentioning

confidence: 99%

Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: A systematic review and meta-analysis

Qureshi

Perera

2017

Annals of Medicine &Amp; Surgery

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“…Subsequently, two randomized controlled trials compared LMWH and UFH. The first showed a significantly lower mortality rate in the LMWH group (0% vs. 18.8%) , whereas the second showed no differences between the two groups in mortality (3.8% vs. 5.6%) and in new symptomatic intracranial hemorrhage (none in both groups) . UFH, with its shorter half‐life and easier reversibility, can be preferred in unstable patients or in those requiring invasive procedures.…”

Section: Treatment Of the Acute Phasementioning

confidence: 92%

Cerebral venous sinus thrombosis

Capecchi

Abbattista

Martinelli

2018

Journal of Thrombosis and Haemostasis

164

174

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The cerebral venous system is an unusual site of thrombosis, with a particularly high incidence in young adults. This incidence has increased in past decades because of the improvement of neuroradiological techniques. Risk factors for cerebral venous sinus thrombosis overlap with those of other venous thromboembolism sites; however, some are specific for this particular anatomical district. Prognosis is favorable in most cases if diagnosis is made rapidly and treatment is promptly initiated, even if acute complications or chronic invalidity still occur in a quarter of patients. The mainstay of treatment is anticoagulation, which is necessary in order to block clot propagation and obtain recanalization. Intracranial bleeding does not contraindicate anticoagulation. Endovascular procedures are reserved for patients with a particularly severe presentation or rapidly declining neurological symptoms despite appropriate anticoagulation, although data from clinical trials are lacking. Specifically, this review addresses the epidemiology, clinical presentation and course, risk factors, and treatment of cerebral venous sinus thrombosis, with a special focus on the pediatric population.

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“…33 After 2000, two additional small trials suggested that low-molecular-weight heparin (LMWH) was superior to unfractionated heparin (UFH). 34,35 Unfortunately, this evidence cannot be applied as such to the subgroup of dural STP. One of the two original trials excluded dural STP 31 ; the two more recent trials included it, but did not provide specific results for this patient subgroup.…”

Section: Anticoagulationmentioning

confidence: 99%

“…One of the two original trials excluded dural STP 31 ; the two more recent trials included it, but did not provide specific results for this patient subgroup. 34,35 Only two observational studies have specifically addressed anticoagulation in dural STP. A single-center analysis of 19 cases seen over 44 years suggested that heparin may reduce mortality in selected cases of septic cavernous sinus thrombosis.…”

Section: Anticoagulationmentioning

confidence: 99%

Head, Neck, and Abdominopelvic Septic Thrombophlebitis: Current Evidence and Challenges in Diagnosis and Treatment

Valerio

Riva

2020

Hamostaseologie

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Septic thrombophlebitis (STP) is a complex, cross-disciplinary clinical condition that combines a localized infection with a neighboring venous thrombosis. STP can occur at several possible anatomic sites, such as dural sinuses, jugular vein (Lemierre syndrome), portal vein (pylephlebitis), and pelvic veins. Its high mortality in the preantibiotic era improved considerably with the introduction of modern antibiotics. However, little evidence exists to date to guide its clinical management. The incidence of STP or its risk factors may be increasing, and its mortality may still be considerable. These trends would have far-reaching implications, especially in the setting of increasing resistance to antimicrobial agents. No clinical assessment tools exist to support patient screening or guide treatment in STP. Few interventional studies exist on the efficacy and safety of anticoagulation. Recommendations on its indications, duration, and the agents of choice are mostly based on evidence derived from small observational studies. While all forms of STP pose similar challenges, future research may benefit from the distinction between bacteria-associated, virus-associated, and mycosis-associated thrombophlebitis. Addressing these gaps in evidence would enhance our ability to diagnose this condition and treat patients effectively.

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The efficacy and safety of low-molecular-weight heparin and unfractionated heparin in the treatment of cerebral venous sinus thrombosis

Cited by 29 publications

References 16 publications

Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: A systematic review and meta-analysis

Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: A systematic review and meta-analysis

Cerebral venous sinus thrombosis

Head, Neck, and Abdominopelvic Septic Thrombophlebitis: Current Evidence and Challenges in Diagnosis and Treatment

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