Treatment of Patients with Cerebral Sinus and Vein Thrombosis with Heparin

Meister, W; Einhaeupl, K. M.; Villringer, Arno; Schmiedek, Peter; Haberl, R.; Pfister, Helmut; Pellkofer, M.; Steinhoff, H.; Deckert, M.; Anneser, Franziska

doi:10.1007/978-1-4684-8199-0_21

Cited by 9 publications

(5 citation statements)

References 8 publications

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“…These treatments are controversial because of the risk of hemorrhage in the brain. 10,14,27,33 In the acute stage after skull base surgery, heparin therapy may be of questionable value considering the invasive manipulation that occurs during surgery. Anticoagulation therapy should be considered as a preventive or therapeutic measure for sigmoid sinus occlusion after the transpetrosal approach is performed in patients with obvious injury to the sigmoid sinus, those who tend toward dehydration postoperatively, those who have little brain contusion, or in those whom brain contusion has improved.…”

Section: Treatment Of Postoperative Occlusion Of the Sigmoid Sinusmentioning

confidence: 99%

Occlusion of the sigmoid sinus after surgery via the presigmoidal—transpetrosal approach

Ohata¹,

Haque²,

Morino³

et al. 1998

Journal of Neurosurgery

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Section: Treatment Of Postoperative Occlusion Of the Sigmoid Sinusmentioning

confidence: 99%

Occlusion of the sigmoid sinus after surgery via the presigmoidal—transpetrosal approach

Ohata¹,

Haque²,

Morino³

et al. 1998

Journal of Neurosurgery

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“…Therefore, outcome is determined by the efficacy of the microcirculatory bed to communicate with collateral outflow pathways and will benefit from measures to eliminate additional risk factors. In addition to heparinization 24 and attempts to lyse the thrombus, 2526 treatment to improve the cerebral microcirculation might be considered during the therapy of patients with SVT.…”

Section: Plot Of Changes In Laser Doppler Volume Fraction Expressementioning

confidence: 99%

Cerebral blood flow alterations in a rat model of cerebral sinus thrombosis.

Ungersböck¹,

Heimann²,

Kempski³

1993

Stroke

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Outcome from sinus vein thrombosis is very variable, with symptoms from headache to coma. Experimental findings suggest that an involvement of cortical veins is necessary to affect the cerebral microcirculation. Laser Doppler flowmetry was used to investigate the regional and temporal changes in local cortical blood flow after experimental occlusion and thrombosis of the superior sagittal sinus and tributary cortical veins in rats. Thrombosis was induced by slow injection of kaolin-cephalin suspension after frontal and caudal ligation of the sagittal sinus in rats. Local cerebral blood flow was measured by laser Doppler flowmetry and correlated with parenchymal damage found 24 hours after induction of thrombosis. Local cerebral blood flow 1 hour after sinus occlusion and induction of thrombosis had decreased to 60.92 +/- 29.05% (p < 0.01); however, there was a large variability among individual animals. Only five of 12 rats showed histological damage and intracerebral hemorrhages 24 hours after induction of thrombosis. A subgroup analysis revealed that parenchymal damage occurred in concurrence with reduced blood flow values after sinus ligation and injection of the thrombogenic material. Sinus thrombosis alone, without alteration of blood flow, did not cause tissue necrosis. The data support the contention that sinus vein thrombosis evolves gradually, with major symptoms occurring only if the thrombus expands from the sinus into bridging and cortical veins. Collateral venous outflow pathways are thereby occluded, and local blood flow may become reduced to and below the ischemic threshold.

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“…One patient treated with low-molecular-weight heparin had a major gastrointestinal hemorrhage, and one patient in the placebo-treated group died of pulmonary embolism. 138 I fi nd the data quite convincing that heparin and low-molecular-weight heparin are not associated with clinical worsening and do not predispose to ICH. Heparin should be given to patients with intracranial dural and venous thrombosis, "whatever the clinical or neuroimaging pattern," 140 unless a strong contraindication is present.…”

Section: Treatmentmentioning

confidence: 93%

“…137 Einhaupl et al also retrospectively analyzed their data from 102 patients with angiographically proven intracranial dural sinus and venous occlusions studied between 1977 and 1991. 137,138 Among the 102 patients, 43 had an ICH. Two patients had their fi rst ICH after heparin treatment.…”

Section: Treatmentmentioning

confidence: 99%

“…The patients not treated with heparin fared worse and had a higher mortality. 137,138 Another randomized trial studied the use of low-molecular-weight heparin in patients with dural sinus thrombosis. 139 No statistically significant difference existed in outcome between the 30 patients treated with low-molecular-weight heparin and the 30 patients given placebo.…”

Section: Treatmentmentioning

confidence: 99%

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