Risk of recurrence of cerebral venous and sinus thrombosis during subsequent pregnancy and puerperium

Abstract

Objective: To assess the risk of recurrence of cerebral venous and sinus thrombosis (CVST) during subsequent pregnancy and puerperium in women with previous cerebral venous occlusive disease. Methods: The authors retrospectively studied the relapse rate of CVST and the incidence of extracerebral venous thrombosis during subsequent pregnancies in 39 women (from 125 patients with CVST) who suffered a CVST at childbearing age. Results: Mean follow up was 10.25 years (range 1 to 20). Twenty two pregnancies and 19 births were observed in 14 women without evidence of either recurrence of CVST or extracerebral venous thrombosis. One pregnancy occurred during oral anticoagulation and was interrupted and two pregnancies ended with spontaneous abortions. Low dose heparin had been given during five pregnancies. Conclusions: The risk of recurrence for CVST during pregnancy seems to be low and these data do not justify a negative advice on pregnancy in women with previous CVST. Further studies are needed to evaluate the need for a prophylactic anticoagulation during pregnancy and puerperium.H ormonal changes during pregnancy and the puerperium carry an increased risk of venous thromboembolism (VTE) including cerebral venous and sinus thrombosis (CVST).1-3 Very little is known about the relapse rate during pregnancy and puerperium in women with a history of CVST. As CVST is nowadays largely a disease of younger women and hormonal factors such as the intake of oral contraceptives 4 5 or pregnancy are important risk factors in a large proportion of female patients, counselling of such women regarding future pregnancies remains a problem in clinical practice. We studied the course and complications of further pregnancies as well as the relapse rate in women with previous CVST at childbearing age. PATIENTS AND METHODSA total of 125 consecutive patients with CVST treated between 1976 and 1996 were identified from hospital charts. Diagnosis had been confirmed by conventional angiography or magnetic resonance angiography in all patients. Eighteen patients (14.6%) had died during the acute stage and 12 had died during the follow up period. Additional 10 patients were lost to follow up and three refused to participate in the study. The remaining 82 patients were eligible for the study. Of these, 39 (47.5%) were women and had been at childbearing age (18-40 years) when the CVST occurred.Data were obtained by phone interviews using a standardised questionnaire. It contained questions on the CVST relapse rate and the long term outcome and was sent to all 82 patients. One part of the questionnaire focused on subsequent pregnancies asking for (1) recurrence of CVST (and its delay to the previous CVST and how the diagnosis was established) (2) incidence of other venous thrombotic events (3) incidence of other pregnancy related complications, and (4) the use and duration of anticoagulation with heparin. Patients who declined a telephone interview were sent the questionnaire by mail. If questions were not or equivocally answered in the mailed...

Safety of Pregnancy After Cerebral Venous Thrombosis

“…Finally, we included 13 studies: 8 studies with long-term follow-up of patients with CVT [16][17][18][19][20][21][22][23] and 5 studies evaluating complications during subsequent pregnancies in women with previous cerebrovascular disease. [24][25][26][27][28] The remaining studies were excluded because of lack of information on the course of pregnancies occurring in women with previous CVT or for providing insufficient data for calculation of rates of thrombotic events and abortion. A MOOSE/PRISMA flowchart summarizes study selection (Figure).…”

“…Дополнительные исследования выявили в результате проведенного ручного поиска среди ссылок в выявленных работах для изучения полного текста работ. В окончательный анализ включили 13 исследований: 8 исследований с длительным периодом наблюдения за пациентками с ЦВТ [16][17][18][19][20][21][22][23] и 5 исследований по оценке осложне-ний во время последующей беременности у женщин с цереброваскулярной патологией в анамнезе [24][25][26][27][28]. Остальные исследования были исключены из-за отсутствия данных о течении беременности у женщин с ЦВТ в анамнезе или по причине предоставления недостаточного количества данных для расчета часто-ты тромбообразования и самопроизвольных абортов.…”

Early Seizures in Cerebral Vein and Dural Sinus Thrombosis

“…The association between presenting seizures and pregnancy/puerperal CVT is less clear. A very high percentage of seizures in pregnancy/puerperal CVT have been mentioned in some series, 5,18,19 but not in others. 20 Possible factors that raise the likelihood of seizures are the young age of pregnant/puerperal women and the concurrence of preeclampsia.…”

Venous Thromboembolic Events After Cerebral Vein Thrombosis

“…14 It is important to note that a significant proportion of women had the initial CVT while on oral contraceptives and during pregnancy or the postpartum period. These factors are established transient risk factors for venous thrombosis 15,16 and could explain the lower rate of further thrombotic events among women. However, we could not find a significant difference in thrombotic recurrence between women with and without these gender-specific risk factors, which favors the existence of other gender-specific risk factors.…”