🧠 Cerebral Venous Sinus Thrombosis (CVST) Management
By whether hemorrhage is present and whether there is progressive deterioration, give anticoagulation, oral maintenance, endovascular/decompression and symptomatic direction. Instant, browser-side.
Cerebral Venous Sinus Thrombosis (CVST) Management
Concomitant hemorrhagic venous infarction
Progressive deterioration despite full anticoagulation / herniation
When to use
Management framing of cerebral venous sinus thrombosis.
How it works
Acute phase → therapeutic anticoagulation with LMWH (preferred over unfractionated), given even with hemorrhagic venous infarction. Transition to warfarin (INR 2–3) or a DOAC; duration provoked 3–6 mo, unprovoked 6–12 mo, recurrent/thrombophilia/cancer long-term. Deterioration despite full anticoagulation → endovascular therapy; herniation → decompressive craniectomy.
Key points
- Anticoagulation is the cornerstone even when a hemorrhagic infarct is present — the hemorrhage is from venous congestion and anticoagulation is proven safe.
- DOACs (dabigatran, apixaban/rivaroxaban) are non-inferior to warfarin; warfarin is preferred in antiphospholipid syndrome / active cancer / renal impairment.
- Manage raised ICP (acetazolamide, lumbar drainage/shunt for vision-threatening isolated intracranial hypertension) and seizures; steroids are not routinely used.
- Find and treat the trigger; women with prior CVST should avoid estrogen-progestin contraception.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.