Treatment Variations in Cerebral Venous Thrombosis: An International Survey

Stroke Notepatients in last 5 years.Ninety-two percent considered heparin the standard therapy for CVT and 87% did not regard intracranial hemorrhage a contraindication for commencing heparin therapy ( fig. 1 ).Sixty-four percent reported using UFH and 36% LMWH.Eight percent of the respondents prescribed prophylactic AED in all patients and 21% only in patients with focal cerebral lesions.The remaining 71% never prescribed prophylactic AED.With regard to long-term antithrombotic therapy, 81% stated that they prescribe oral anticoagulants in all patients, unless there is an absolute contraindication.The duration of treatment varied: 13% usually treat for 3 months, 64% for 6 months and 20% for 1 year.Regarding more invasive therapies, 43% had used endovascular thrombolysis, the majority in less than 5 patients ( fig. 2 ).Eighty-four percent used rt-PA and the remainder urokinase.When asked if they would consider decompressive craniectomy in a patient with impending cerebral herniation due to focal cerebral lesions, 93% responded positively, 43% had actually used this treatment.Compared to other physicians, neurologists were more inclined to treat a patient with decompressive craniectomy (96 vs. 79%, OR 6.7, p = 0.03) and more frequently prescribed oral anticoagulation during the chronic phase (84 vs. 57%, OR 4.4, p = 0.02).On the other hand, neurologists were much less likely to prescribe prophylactic AED (21 vs. 77%, OR 0.08, p ! 0.001).