Cerebral venous thrombosis

ABSTRACT

Cerebral venous sinus thrombosis (CVT) consists of partial or complete occlusion of a sinus or a cerebral vein. CVT represents 0.5-1% of all strokes and is more frequent in young women. This review discusses particular aspects of CVT diagnosis and management: decompressive craniectomy (DC), anticoagulation with direct oral anticoagulants (DOACs), CVT after coronavirus-disease 19 (COVID-19) and Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT).

RESUMO

A trombose venosa cerebral (TVC) consiste na oclusão parcial ou completa de um seio ou de uma veia cerebral. A TVC representa 0,5-1% das doenças cerebrovasculares e é mais frequente em mulheres jovens. Esta revisão discute aspectos específicos do diagnóstico e do manejo da TVC: craniectomia descompressiva (DC), anticoagulação com anticoagulantes orais diretos (DOACs), TVC após infecção por coronavírus (COVID-19) e Trombocitopenia Trombótica Imune Induzida por Vacina (VITT).

Keywords:

Sinus Thrombosis, Intracranial - Decompressive Craniectomy - COVID-19 - COVID-19 Vaccines.

Palavras-chave:

Trombose dos Seios Intracranianos - Craniectomia Descompressiva - COVID-19 - Vacinas contra COVID-19

Author’s contributions:

AAAMJ: performed the research; Wrote the manuscript; ABC: conception and design of the study; revised and approved the final manuscript

Publication History

Received: 15 March 2022

Accepted: 29 April 2022

Article published online:
06 February 2023

• References

• 1 Silvis SM, Sousa DA, Ferro JM, Coutinho JM. Cerebral venous thrombosis. Nat Rev Neurol 2017; 13 (09) 555-565 https://doi.org/10.1038/nrneurol.2017.104
• 2 Ulivi L, Squitieri M, Cohen H, Cowley P, Werring DV. Cerebral venous thrombosis: a practical guide. Pract Neurol 2020; 20 (05) 356-367 https://doi.org/10.1136/practneurol-2019-002415
• 3 Idiculla PS, Gurala D, Palanisamy M, Vijayakumar R, Dhandapani S, Nagarajan E. Cerebral venous thrombosis: a comprehensive review. Eur Neurol 2020; 83 (04) 369-379 https://doi.org/10.1159/000509802
• 4 Ferro JM, Canhão P, Stam J, Bousser M-G, Barinagarrementeria F. ISCVT Investigators. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT). Stroke 2004; 35 (03) 664-670 https://doi.org/10.1161/01.STR.0000117571.76197.26
• 5 Zhang S, Zhao H, Li H, You C, Hui X. Decompressive craniectomy in hemorrhagic cerebral venous thrombosis: clinicoradiological features and risk factors. J Neurosurg 2016; 127 (04) 709-715 https://doi.org/10.3171/2016.8.JNS161112
• 6 Ferro JM, Coutinho JM, Dentali F, Kobayashi A, Alasheev A, Canhão P. et al. Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: a randomized clinical trial. JAMA Neurol 2019; 76 (12) 1457-1465 http://doi.org/10.1001/jamaneurol.2019.2764
• 7 Ferro JM, Bacelar-Nicolau H, Rodrigues T, Bacelar-Nicolau L, Canhão P, Crassard I. et al. Risk score to predict the outcome of patients with cerebral vein and dural sinus thrombosis. Cerebrovasc Dis 2009; 28 (01) 39-44 https://doi.org/10.1159/000215942
• 8 Ferro JM, Canhão P, Sousa DA. Cerebral venous thrombosis. Presse Med 2016; Dec;45(12 Pt 2): e429-e450 https://doi.org/10.1016/j.lpm.2016.10.007
• 9 Ferro JM, Crassard I, Coutinho JM, Canhão P, Barinagarrementeria F, Cucchiara B. et al. Decompressive surgery in cerebrovenous thrombosis: a multicenter registry and a systematic review of individual patient data. Stroke 2011; 42 (10) 2825-2831 https://doi.org/10.1161/STROKEAHA.111.615393
• 10 Coutinho JM, Majoie CBLM, Coert BA, Stam J. Decompressive hemicraniectomy in cerebral sinus thrombosis: consecutive case series and review of the literature. Stroke 2009; 40 (06) 2233-2235 https://doi.org/10.1161/STROKEAHA.108.543421
• 11 Théaudin M, Crassard I, Bresson D, Saliou G, Favrole P, Vahedi K. et al. Should decompressive surgery be performed in malignant cerebral venous thrombosis? A series of 12 patients. Stroke 2010; 41 (04) 727-731 https://doi.org/10.1161/STROKEAHA.109.572909
• 12 Aaron S, Alexander M, Moorthy RK, Mani S, Mathew V, Patil AKB. et al. Decompressive craniectomy in cerebral venous thrombosis: a single centre experience. J Neurol Neurosurg Psychiatry 2013; 84 (09) 995-1000 https://doi.org/10.1136/jnnp-2012-303356
• 13 Raza E, Shamim MS, Wadiwala MF, Ahmed B, Kamal AK. Decompressive surgery for malignant cerebral venous sinus thrombosis: a retrospective case series from Pakistan and comparative literature review. J Stroke Cerebrovasc Dis 2014; 23 (01) e13-e22 https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.07.045
• 14 Schultz NH, Sørvoll IH, Michelsen AE, Munthe LA, Lund-Johansen F, Ahlen MT. et al. Thrombosis and thrombocytopenia after ChAdOx1 nCoV-19 vaccination. N Engl J Med 2021; 384 (22) 2124-2130 https://doi.org/10.1056/NEJMoa2104882
• 15 Rajwani KM, Crocker M, Moynihan B. Decompressive craniectomy for the treatment of malignant middle cerebral artery infarction. Br J Neurosurg 2017; 31 (04) 401-409 https://doi.org/10.1080/02688697.2017.1329518
• 16 Avanali R, Gopalakrishnan MS, Devi BI, Bhat DI, Shukla DP, Shanbhag NC. Role of decompressive craniectomy in the management of cerebral venous sinus thrombosis. Front Neurol 2019; 10: 511-511 https://doi.org/10.3389/fneur.2019.00511
• 17 van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19 (05) 604-607 https://doi.org/10.1161/01.str.19.5.604
• 18 Vivakaran TTR, Srinivas D, Kulkarni GB, Somanna S. The role of decompressive craniectomy in cerebral venous sinus thrombosis. J Neurosurg 2012; 117 (04) 738-744 https://doi.org/10.3171/2012.6.JNS11102
• 19 McMillan T, Wilson L, Ponsford J, Levin H, Teasdale G, Bond M. The Glasgow Outcome Scale - 40 years of application and refinement. Nat Rev Neurol 2016; 12 (08) 477-485 https://doi.org/10.1038/nrneurol.2016.89
• 20 Aaron S, Van Kammen MS, Conforto A, Arauz A, Carvalho M, Masjuan J. et al. Decompressive neurosurgery for patients with severe cerebral venous thrombosis: final results of the DECOMPRESS2 study [Internet]. Eur Stroke J. 2021 Sep 1 [2022 Mar 13]. Available from: https://journals.sagepub.com/doi/full/10.1177/23969873211034932
• 21 Saposnik G, Barinagarrementeria F, Brown Jr RD, Bushnell CD, Cucchiara B, Cushman M. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (04) 1158-1192 https://doi.org/10.1161/STR.0b013e31820a8364
• 22 Ferro JM, Bousser M-G, Canhão P, Coutinho JM, Crassard I, Dentali F. et al. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24 (10) 1203-1213 https://doi.org/10.1111/ene.13381
• 23 Mahale R, Mehta A, Varma RG, Hegde AS, Purushottam TA, Srinivasa R. Decompressive surgery in malignant cerebral venous sinus thrombosis: what predicts its outcome?. Thromb Thrombolysis 2017; 43 (04) 530-539 https://doi.org/10.1007/s11239-017-1489-x
• 24 Pizzi MA, Alejos DA, Siegel JL, Kim BYS, Miller DA, Freeman WD. Cerebral venous thrombosis associated with intracranial hemorrhage and timing of anticoagulation after hemicraniectomy. J Stroke Cerebrovasc Dis 2016; 25 (09) 2312-2316 https://doi.org/10.1016/j.jstrokecerebrovasdis.2016.05.025
• 25 Einhäupl KM, Villringer A, Meister W, Mehraein S, Garner C, Pellkofer M. et al. Heparin treatment in sinus venous thrombosis. Lancet 1991; 338 8767 597-600 https://doi.org/10.1016/0140-6736(91)90607-q
• 26 de Bruijn SFTM, Stam J. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke 1999; 30: 484-488 https://doi.org/10.1161/01.STR.30.3.484
• 27 Coutinho J, de Bruijn SFTM, deVeber G, Stam J. Anticoagulation for cerebral venous sinus thrombosis. Cochrane Database Syst Rev 2011; 2011 (08) CD002005 https://doi.org/10.1002/14651858.CD002005.pub2
• 28 Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H. et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest 2016; 149 (02) 315-352 https://doi.org/10.1016/j.chest.2015.11.026
• 29 Ortel TL, Neumann I, Ageno W, Beyth R, Clark NP, Cuker A. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19) 4693-4738 https://doi.org/10.1182/bloodadvances.2020001830
• 30 January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland Jr JC. et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation 2019; 140 (02) e125-e151 https://doi.org/10.1161/CIR.2022s1082022s1080665
• 31 Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J 2021; 42 (05) 373-498 https://doi.org/10.1093/eurheartj/ehaa612
• 32 Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A. et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009; 361 (12) 1139-1151 https://doi.org/10.1056/NEJMoa0905561
• 33 Patel MR, Mahaffey KW, Garg J, Pan G, Singer DE, Hacke W. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med 2011; 365 (10) 883-891 https://doi.org/10.1056/NEJMoa1009638
• 34 Granger CB, Alexander JH, McMurray JJV, Lopes RD, Hylek EM, Hanna M. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2011; 365 (11) 981-992 https://oi.org/10.1056/NEJMoa1107039
• 35 Giugliano RP, Ruff CT, Braunwald E, Murphy AS, Wiviott SD, Halperin JL. et al. Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med 2013; 369 (22) 2093-2104 https://doi.org/10.1056/NEJMoa1310907
• 36 Agnelli G, Buller HR, Cohen A, Curto M, Gallus AS, Johnson M. et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med 2013; 369 (09) 799-808 https://doi.org/10.1056/NEJMoa1302507
• 37 Connor P, van Kammen MS, Lensing AWA, Chalmers E, Kállay K, Hege K. et al. Safety and efficacy of rivaroxaban in pediatric cerebral venous thrombosis (EINSTEIN-Jr CVT). Blood Adv 2020; 4 (24) 6250-6258 https://doi.org/10.1182/bloodadvances.2020003244
• 38 Nepal G, Kharel S, Bhagat R, Shing YK, Coghlan MA, Poudyal P. et al. Safety and efficacy of direct oral anticoagulants in cerebral venous thrombosis: a meta-analysis. Acta Neurol Scand 2022; 145 (01) 10-23 https://doi.org/10.1111/ane.13506
• 39 Yaghi S, Shu L, Bakradze E, Omran SS, Giles JA, Amar JY. et al. Direct oral anticoagulants versus warfarin in the treatment of cerebral venous thrombosis (ACTION-CVT): a multicenter international study. Stroke 2022; 53 (03) 728-738 https://doi.org/10.1161/STROKEAHA.121.037541
• 40 Sayar Z, Moll R, Isenberg D, Cohen H. Thrombotic antiphospholipid syndrome: a practical guide to diagnosis and management. Thromb Res 2021; 198: 213-221 https://doi.org/10.1016/j.thromres.2020.10.01
• 41 Hameed S, Wasay M, Soomro BA, Mansour O, Abd-allah F, Tu T. et al. Cerebral venous thrombosis associated with COVID-19 infection: an observational, multicenter study. Cerebrovasc Dis Extra 2021; 11 (02) 55-60 https://doi.org/10.1159/000516641
• 42 Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM. et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020; 191: P145-P147 https://doi.org/10.1016/j.thromres.2020.04.013
• 43 Hughes C, Nichols T, Pike M, Subbe C, Elghenzai S. Cerebral venous sinus thrombosis as a presentation of COVID-19. Eur J Case Rep Intern Med 2020; 7 (05) 001691-001691 https://doi.org/10.12890/2020_001691
• 44 Baldini T, Asioli GM, Romoli M, Dias MC, Schulte EC, Hauer L. et al. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: a systematic review and meta-analysis. Eur J Neurol 2021; 28 (10) 3478-3490 https://doi.org/10.1111/ene.14727
• 45 Ghosh R, Roy D, Mandal A, Pal SK, Swaika BC, Naga D. et al. Cerebral venous thrombosis in COVID-19. Diabetes Metab Syndr 2021; 15 (03) 1039-1045 https://doi.org/10.1016/j.dsx.2021.04.026
• 46 Hinduja A, Nalleballe K, Onteddu S, Kovvuru S, Hussein O. Impact of cerebral venous sinus thrombosis associated with COVID-19. J Neurol Sci 2021; 425: 117448-117448 https://doi.org/10.1016/j.jns.2021.117448
• 47 Tu TM, Goh C, Tan YK, Leow AS, Pang YZ, Chien J. et al. Cerebral venous thrombosis in patients with COVID-19 Infection: a case series and systematic review. J Stroke Cerebrovasc Dis 2020; 29 (12) 105379-105379 https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105379
• 48 Greinacher A, Thiele T, Warkentin TE, Weisser K, Kyrle PA, Eichinger S. Thrombotic Thrombocytopenia after ChAdOx1 nCov-19 vaccination. N Engl J Med 2021; 384 (22) 2092-2101 https://doi.org/10.1056/NEJMoa2104840
• 49 See I, Su JR, Lale A, Woo EJ, Guh AY, Shimabukuro TT. et al. US case reports of cerebral venous sinus thrombosis with thrombocytopenia after Ad26.COV2.S vaccination, March 2 to April 21, 2021. JAMA 2021; 325 (24) 2448-2456 https://doi.org/10.1001/jama.2021.7517
• 50 Greinacher A. Heparin-induced thrombocytopenia. N Engl J Med 2015; 373 (03) 252-261 https://doi.org/10.1056/NEJMcp1411910
• 51 Ministério da Saúde, Secretaria de Vigilância em Saúde. Nota técnica nº 933/2021-CGPNI/DEIDT/SVS/MS [Internet]. Brasília (DF):: Ministério da Saúde; 2021. 2022 Mar 13 Available from: https://sbim.org.br/images/files/notas-tecnicas/nota-tecnica-no-9332021-cgpnideidtsvsms.pdf
• 52 Bilotta C, Perrone G, Adelfio V, Spatola GF, Uzzo ML, Argo A. et al. COVID-19 vaccine-related thrombosis: a systematic review and exploratory analysis. Front Immunol 2021; 12: 729251-729251 https://doi.org/10.3389/fimmu.2021.729251
• 53 Sharifian-Dorche M, Bahmanyar M, Sharifian-Dorche A, Mohammadi P, Nomovi M, Mowla A. Vaccine-induced immune thrombotic thrombocytopenia and cerebral venous sinus thrombosis post COVID-19 vaccination; a systematic review. J Neurol Sci 2021; 428: 117607-117607 https://doi.org/10.1016/j.jns.2021.117607
• 54 Thakur KT, Tamborska A, Wood GK, Mcneill E, Roh D, Akpan IJ. et al. Clinical review of cerebral venous thrombosis in the context of COVID-19 vaccinations: evaluation, management, and scientific questions. J Neurol Sci 2021; 427: 117532-117532 https://doi.org/10.1016/j.jns.2021.117532
• 55 Pavord S, Lester W, Makris M, Scully M, Hunt B. Guidance from the Expert Haematology Panel (EHP) on Covid-19 Vaccine-induced Immune Thrombocytopenia and Thrombosis (VITT) [Internet]. 2021 Aug 31 [cited 2022 Mar 13]. 6 p. Available from: https://b-s-h.org.uk/media/20499/guidance-version-22-20210903.pdf
• 56 Franchini M, Liumbruno GM, Pezzo M. COVID-19 vaccine-associated immune thrombosis and thrombocytopenia (VITT): diagnostic and therapeutic recommendations for a new syndrome. Eur J Haematol 2021; 107 (02) 173-180 https://doi.org/10.1111/ejh.13665
• 57 Salih F, Schönborn L, Kohler S, Franke C, Möckel M, Dörner T. et al. Vaccine-induced thrombocytopenia with severe headache. N Engl J Med 2021; 385 (22) 2103-2105 https://doi.org/10.1056/NEJMc2112974
• 58 Bikdeli B, Chatterjee S, Arora S, Monreal M, Jimenez D, Krumholz HM. et al. Cerebral venous sinus thrombosis in the U.S. population, after adenovirus-based SARS-CoV-2 vaccination, and after COVID-19. J Am Coll Cardiol 2021; 78 (04) 408-411 https://doi.org/10.1016/j.jacc.2021.06.001