Clinical course of traumatic cerebral venous sinus thrombosis: Insights from a UK major trauma centre

Background Traumatic venous sinus thrombosis (tCVST) is a recognised complication of traumatic brain injury (TBI), usually secondary to adjacent skull fractures or intracranial haemorrhage. The optimal timing of diagnostic CT venography (CTV) and anticoagulation initiation remains uncertain. Methods A retrospective cohort study was performed at Queen Elizabeth Hospital Birmingham, a UK Major Trauma Centre, including patients aged > 16 years with radiologically-confirmed tCVST between January 2020-December 2023 who survived ≧48 h after TBI. Demographics, injury characteristics, treatment, radiological and functional outcomes were analysed. Five inpatient anticoagulation pathways were recorded descriptively and collapsed into three clinically interpretable categories for comparative analyses: no LMWH, prophylactic LMWH only and any therapeutic-dose anticoagulation exposure. Results 56/1411 TBI admissions (4%) had tCVST. Patients were predominantly male (68%) with a mean age of 40.9 years. Skull fractures were present in 53/56 patients (95%), with 50/56 (89.3%) directly overlying the thrombosed sinus; lateral sinuses were most frequently affected. Anticoagulation was administered to 50/56 patients, commencing ≦48 h in 74% and ≦5 days in 90% of treated patients. Follow-up CTV was available in 47 patients; 10 had full recanalisation, 22 had partial recanalization or non-occlusive residual thrombus, and 15 had no recanalisation. There was no statistically significant difference in 3-month GOS-E between anticoagulation categories. No inpatient anticoagulation-related intracranial haemorrhage or neurological deterioration was observed; one patient developed delayed gastrointestinal bleeding during outpatient follow-up. Conclusions In this UK Major Trauma Centre cohort, early LMWH-based anticoagulation was commonly used in selected tCVST patients without observed inpatient anticoagulation-related intracranial haemorrhagic deterioration. However, the study was underpowered to determine treatment efficacy. Prospective multicentre studies are required to define risk stratification, anticoagulation timing and intensity, and follow-up venous imaging strategy.