Cerebral Venous Thrombosis

Elio Agostoni; Angelo Aliprandi; Marco Longoni


Expert Rev Neurother. 2009;9(4):553-564. 

In This Article

Five-year View

Although the most recent, large, epidemiologic studies have clarified many clinical and etiologic aspects of CVT, some issues are still uncertain and open to debate, especially concerning the most appropriate therapeutic approach. In fact, as we have already pointed out, the evidence available for the use of anticoagulation in all patients with the disease is still insufficient and based on trials of small size. However, a trial comparing anticoagulants against placebo is unlikely as most clinicians would consider it unacceptable not to treat patients with heparin. A more probable development could be a trial testing anticoagulants against thrombolysis As a matter of fact, so far, thrombolytic treatment has been used in the most severe patients or in those who worsen despite anticoagulation, but no evidence is available from randomized trials. Furthermore, in clinical practice thrombolitic treatment is highly dependent on the local clinical and interventional expertise. A randomized controlled trial comparing anticoagulants with thrombolitics in a selected group of patients could yield some relevant information and help clinical decisions.

Overall, the most likely future development will probably be the definition of better guidelines for the treatment of CVT, with more specific and targeted indications for the use of anticoagulants and with the definition of a possible role of thrombolysis.

A second important issue will probably be the definition of more accurate diagnostic criteria as most studies have overlooked this aspect. The identification of clinical indicators for an early diagnosis of CVT could lead to more appropriate radiological examinations and could allow earlier treatment, changing the course of the disease. Such a task might be accomplished through prospective cohort studies specifically designed to assess the presenting symptoms.


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