Cerebral Venous Sinus Thrombosis in Women: Subgroup Analysis of the VENOST Study

Abstract

Background. Early diagnosis of cerebral venous sinus thrombosis (CVST) associated with reproductive health-related risk factors (RHRF) including pregnancy, puerperium, and oral contraceptive (OC) use can prevent severe neurological sequelae; thus, the symptoms must be documented in detail for each group. Methods. Out of 1144 patients with CVST, a total of 777 women were enrolled from a multicenter for the study of cerebral venous sinus thrombosis (VENOST). Demographic, biochemical, clinical, and radiological aspects were compared for 324 cases with RHRF and 453 cases without RHRF. Results. The mean age of the RHRF (-) group (43.2 ± 13 years) was significantly higher than of the RHRF (+) group (34±9 years). A previous history of deep venous thrombosis (3%), isolated cavernous sinus involvement (1%), cranial neuropathy (13%), comorbid malignancy (7%), and its disability scores after 12 months (9%) were significantly higher in the RHRF (-) group. The RHRF (+) group consisted of 44% cases of puerperium, 33% cases of OC users and 23% of pregnant women. The mean age was found to be higher in OC users (38±9 years). A previous history of deep venous thrombosis was slightly higher in the pregnancy subgroup (4%). Epileptic seizures were more common in the puerperium group (44%). Conclusion. The results of our study indicate that the risk of CSVT increases parallel to age, OC use, and puerperium period. In addition, when considering the frequency of findings and symptoms, epileptic seizures in the puerperium subgroup of the RHRF (+) group and malignancies in the RHRF (-) group may accompany the CSVT. In daily practice, predicting these risks for the CSVT and early recognition of the symptoms will provide significant benefits to patients.

Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

“…In our cohort of obstetric CVT, despite the fact that anemia was not validated in the final model as the highest association variable for bad functional outcome and death, it remained as an important associated factor, which should be explored in terms of not the presence of hemoglobin decrease, but also hematologic intrinsic effects in hemostasis and thrombi formation, which was not explored in our study. Protein C/S deficiency and hyperhomocysteinemia were other frequently identified risk factors present in one-fifth of our tested patients, a finding contrasting VENOST study [30], but similar to a report by Klai et al [31].…”

“…years [IQR [23][24][25][26][27][28][29][30][31][32][33][34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified.…”

Venous Thromboembolism in Women of Childbearing Age: Insights from the START Registry

“…These data are consistent with previous studies, showing that women in childbearing age are more prone to these life-threatening thrombotic events due to their exposition to hormonal therapies or pregnancy. [10][11][12] The relatively high distribution of the most severe VTE manifestations in young women underlines the clinical relevance of this issue and the need to collect as many information as possible on the burden of VTE in this setting. Left lower extremity DVT was more frequently observed than right leg DVT in all groups (►Table 2).…”

Cerebrovascular disease in pregnancy and postpartum

“…Cerebral venous thrombosis (CVT) is more common in women; pregnancy, puerperium, hormonal replacement therapy and in-vitro fertilization further increase risk [57 ▪ ,58]. Pregnancy or puerperium is associated to 11 to 58% of all CVT cases in female patients [59].…”