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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| Vydáno v: | European journal of neurology Ročník 24; číslo 10; s. 1203 - 1213 |
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| Hlavní autoři: | , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
| Vydáno: |
England
John Wiley & Sons, Inc
01.10.2017
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| Témata: | |
| ISSN: | 1351-5101, 1468-1331, 1468-1331 |
| On-line přístup: | Získat plný text |
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| Abstract | 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. |
|---|---|
| AbstractList | 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. 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.BACKGROUND AND PURPOSECurrent 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.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.METHODWe 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.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.RESULTSWe 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.Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT.CONCLUSIONSMulticentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT. 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. Click here for the corresponding questions to this CME article. 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. 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. 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. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of CVT. |
| Author | Crassard, I. Masuhr, F. Martinelli, I. Bousser, M.‐G. Ferro, J. M. Canhão, P. Coutinho, J. M. Stam, J. Minno, M. Maino, A. Dentali, F. Aguiar de Sousa, D. |
| Author_xml | – sequence: 1 givenname: J. M. surname: Ferro fullname: Ferro, J. M. email: jmferro@medicina.ulisboa.pt organization: Universidade de Lisboa – sequence: 2 givenname: M.‐G. surname: Bousser fullname: Bousser, M.‐G. organization: Hôpital Lariboisière – sequence: 3 givenname: P. surname: Canhão fullname: Canhão, P. organization: Universidade de Lisboa – sequence: 4 givenname: J. M. surname: Coutinho fullname: Coutinho, J. M. organization: Academic Medical Center – sequence: 5 givenname: I. surname: Crassard fullname: Crassard, I. organization: Hôpital Lariboisière – sequence: 6 givenname: F. surname: Dentali fullname: Dentali, F. organization: Insubria University – sequence: 7 givenname: M. surname: Minno fullname: Minno, M. organization: IRCCS – sequence: 8 givenname: A. surname: Maino fullname: Maino, A. organization: Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico – sequence: 9 givenname: I. surname: Martinelli fullname: Martinelli, I. organization: Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico – sequence: 10 givenname: F. surname: Masuhr fullname: Masuhr, F. organization: Bundeswehrkrankenhaus – sequence: 11 givenname: D. orcidid: 0000-0002-6702-7924 surname: Aguiar de Sousa fullname: Aguiar de Sousa, D. organization: Hospital de Santa Maria – sequence: 12 givenname: J. surname: Stam fullname: Stam, J. organization: Academic Medical Center |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28833980$$D View this record in MEDLINE/PubMed |
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| Keywords | 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 |
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Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological... Click here for the corresponding questions to this CME article. Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological Societies in 2010. We... Background and purpose Current guidelines on cerebral venous thrombosis (CVT) diagnosis and management were issued by the European Federation of Neurological... |
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| SubjectTerms | 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 |
| Title | European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis – endorsed by the European Academy of Neurology |
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