Cerebral venous thrombosis: clinical predictors and emerging treatments
- PDF / 361,682 Bytes
- 3 Pages / 595.276 x 790.866 pts Page_size
- 32 Downloads / 196 Views
JOURNAL CLUB
Cerebral venous thrombosis: clinical predictors and emerging treatments A. Al‑Ansari1 · N. P. Robertson2
© The Author(s) 2020
Introduction Cerebral venous thrombosis (CVT) is a distinct form of stroke primarily affecting young- and middle-aged adults and is a commonly considered differential diagnosis in patients presenting with headache and/or neurological deficit particularly in the context of established risk factors. In general, CVT has a relatively favourable long-term prognosis but challenges remain regarding timely diagnosis and appropriate treatment selection, although a consensus of current published guidelines support the use of anticoagulation. However, development of clinical prediction scores, and expanding knowledge of treatment efficacy, may help to further improve clinical management. This month’s journal club explores three papers relating to CVT. The first paper describes a prospective study of the predictive value of clinical variables and D-dimer levels in patients with clinically possible CVT. The second paper compares endovascular treatment with medical management versus standard anticoagulation for severe CVT. The third paper examines the safety and efficacy of dabigatran etexilate versus warfarin in patients with CVT.
* N. P. Robertson [email protected] 1
Department of Neurology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
2
Prediction of cerebral venous thrombosis with a new clinical score and D‑dimer levels Clinical prediction scores incorporating D-dimer levels are widely used in the evaluation of patients with suspected deep venous thrombosis or pulmonary embolism. This paper describes the development of an equivalent clinical score for stratifying patients into groups with low, moderate and high probability of CVT, and increasing the score’s predictive value by adding D-dimer levels. Between September 2009 and February 2016, adult patients presenting to the neurological emergency departments of the University Hospitals of Bern and Amsterdam with clinically possible CVT were evaluated by a trained neurologist and consented to participate in the study. Inclusion criteria included one or more of isolated unexpected headache, headache with focal neurological deficits, headache associated with seizure and/or unexplained papilloedema. Exclusion criteria comprised anticoagulation treatment prior to admission and deep venous thrombosis, pulmonary embolus, stroke or myocardial infarction in the 3 months prior to admission. Baseline characteristics, demographic data, risk factors and clinical findings were recorded. Plasma samples for standard parameters and D-dimer levels were taken on admission and analysed by blinded laboratory investigators. Diagnosis of CVT was confirmed by MR and/ or CT venography. 359 adults were included in the final analysis, with 94/359 (25.8%) havin
Data Loading...
