Journal: Stroke
This publication reviews current evidence and ongoing gaps in the management of cerebral venous thrombosis (CVT), a rare stroke subtype that predominantly affects younger women.
Key points:
- Disease overview and phases of care: CVT management is framed across the continuum of care—acute management, primary therapy, secondary prevention, and long‑term recovery.
- Acute management:
- Anticoagulation is the cornerstone of treatment, even when intracranial hemorrhage is present.
- Endovascular therapy and decompressive craniectomy are reserved for carefully selected, severe cases.
- Primary anticoagulant therapy:
- Direct oral anticoagulants appear broadly comparable to vitamin K antagonists for most patients.
- Uncertainties remain regarding the optimal initial (lead‑in) strategy and total duration of treatment.
- Secondary prevention:
- Decisions on extended anticoagulation must be individualized, balancing recurrence risk against bleeding risk.
- Highest thromboembolic risk is seen in patients with cancer, antiphospholipid antibody syndrome, prior venous thromboembolism, or idiopathic CVT.
- Long‑term outcomes and morbidity:
- Despite generally high rates of functional independence, many patients experience chronic sequelae such as fatigue, headache, cognitive and mood disturbances, epilepsy, and intracranial hypertension.
- Heavy menstrual bleeding is a specific concern for young women receiving anticoagulation.
- Systematic recognition and management of these long‑term issues are emphasized as critical to comprehensive care.