What is the workup and treatment for cerebral venous thrombosis (CVT) during pregnancy?

Updated: Nov 08, 2018
  • Author: Carmel Armon, MD, MSc, MHS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
  • Print
Answer

Answer

Without treatment, CVT may lead to emergence or progression of stroke, exacerbation of dysfunction, worsening of increased intracranial pressure (ICP) that leads to vision impairment, and persistence of a headache that is difficult to treat.

Therapy for CVT consists of anticoagulation with heparin, which after delivery is switched to warfarin. In rare cases, elevated ICP must be treated. However, acetazolamide is a category C drug (meaning that data about risks in humans are not available), and its risks in infants and children have not been studied. Hence, its use must be preceded by a clear definition of goals and by discussions with the patient and her obstetricians. CVT usually, but not always, resolves. Analgesia is permitted, in accordance with usual obstetric practice.

The underlying genetic or acquired risk factors for a hypercoagulable state are often sought. Little is known about the yield of such a search in patients who have no other history of venous thrombosis or of previous fetal loss. However, the presence or absence of risk factors for hypercoagulability may contribute to decision-making with regard to the duration of warfarin therapy. At present, no data are available to guide recommendations about how long the patient should take warfarin.

The question of the optimal duration of warfarin treatment acquires particular relevance for patients who developed CVT during pregnancy and who wish to become pregnant again, in that warfarin is a category X drug. Reports describe birth malformations in children born to mothers who were treated with warfarin during pregnancy. Furthermore, the drug passes through the placental barrier and may cause fatal hemorrhage in utero.

Consequently, if the decision has been made that the patient requires anticoagulation in her next pregnancy, warfarin should be discontinued and fractionated or unfractionated heparin should be used instead. All therapeutic decisions must be individualized after discussions with the patient.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!