European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology

Background and purpose Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence‐based...

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Veröffentlicht in:	European journal of neurology Jg. 24; H. 10; S. 1203 - 1213
Hauptverfasser:	Ferro, J. M., Bousser, M.‐G., Canhão, P., Coutinho, J. M., Crassard, I., Dentali, F., Minno, M., Maino, A., Martinelli, I., Masuhr, F., Aguiar de Sousa, D., Stam, J.
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	England John Wiley & Sons, Inc 01.10.2017
Schlagworte:	Acetazolamide Angiography Anticoagulants Anticoagulants - therapeutic use anticoagulation Antiepileptic agents antiepileptic drugs Brain Cancer cancer screening cerebral venous thrombosis Computed tomography contraception Contraceptives Decompression, Surgical decompressive surgery Diagnosis Diagnostic systems Drugs dural sinus thrombosis D‐dimers Estrogens Evaluation Grading of Recommendations, Assessment, Development and Evaluation Guidelines hemicraniectomy Heparin Heparin, Low-Molecular-Weight - therapeutic use Humans Intracranial Thrombosis - diagnosis Intracranial Thrombosis - drug therapy Intracranial Thrombosis - surgery Lesions Literature reviews lumbar puncture Magnetic resonance Neurology Oestrogens Patients Pregnancy pro‐thrombotic screening Puerperium Seizing Seizures shunt Steroid hormones Steroids Stroke Surgery thrombectomy Thromboembolism Thrombolysis Thrombophilia Thrombosis venography Venous Thrombosis - diagnosis Venous Thrombosis - drug therapy Venous Thrombosis - surgery D-dimers antiepileptic drugs lumbar puncture cancer screening shunt cerebral venous thrombosis thrombectomy anticoagulation pregnancy hemicraniectomy contraception angiography heparin decompressive surgery Grading of Recommendations, Assessment, Development and Evaluation acetazolamide pro-thrombotic screening thrombolysis dural sinus thrombosis steroids venography puerperium
ISSN:	1351-5101, 1468-1331, 1468-1331
Online-Zugang:	Volltext
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Zusammenfassung:	Background and purpose Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We aimed to update the previous European Federation of Neurological Societies guidelines using a clearer and evidence‐based methodology. Method We followed the Grading of Recommendations, Assessment, Development and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews and writing recommendations based on the quality of available scientific evidence. Results We suggest using magnetic resonance or computed tomographic angiography for confirming the diagnosis of CVT and not routinely screening patients with CVT for thrombophilia or cancer. We recommend parenteral anticoagulation in acute CVT and decompressive surgery to prevent death due to brain herniation. We suggest preferentially using low‐molecular‐weight heparin in the acute phase and not direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that, in women who have suffered a previous CVT, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low‐molecular‐weight heparin should be considered throughout pregnancy and puerperium. Conclusions Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT. Click here for the corresponding questions to this CME article.
Bibliographie:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Instructional Material/Guideline-3 content type line 23
ISSN:	1351-5101 1468-1331 1468-1331
DOI:	10.1111/ene.13381