Cerebral Venous Thrombosis: Anticoagulation Strategies and Recanalisation Rates
DOI:
https://doi.org/10.5281/zenodo.22310537Keywords:
Cerebral venous thrombosis, Anticoagulation, Direct oral anticoagulants, Recanalisation, Endovascular thrombectomyAbstract
Background: Cerebral venous thrombosis (CVT) is an uncommon but treatable stroke subtype causing headache, seizures, focal
deficits or coma. Anticoagulation is its cornerstone, yet optimal agent, duration and role of recanalisation remain debated.
Objective: To review anticoagulation strategies for CVT, including heparin, vitamin K antagonists, direct oral anticoagulants,
endovascular therapy, and recanalisation, plus special populations. Methods: Narrative review of randomised trials, cohorts, registries and guidelines. Findings: Heparin remains first-line even with haemorrhagic infarction. RE-SPECT CVT showed dabigatran comparable to warfarin, and ACTION-CVT supported direct oral anticoagulants in practice. TO-ACT found no added benefit from endovascular
therapy in severe disease. Recanalisation is frequent but correlates poorly with functional outcome. Conclusions: Heparin followed by three to twelve months of oral anticoagulation, guided by provoking factors, remains standard care, with endovascular therapy reserved for deterioration and tailored approaches needed in pregnancy and thrombocytopenic thrombosis.
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