J Clin Neurol.  2005 Oct;1(2):134-141. 10.3988/jcn.2005.1.2.134.

Safety and Feasibility of Subcutaneous Low Molecular Weight Heparin for Cerebral Venous Sinus Thrombosis

• Kim JS
• Jeong SH
• Kim DH
• Kim J

• KMID: 1808483
• DOI: http://doi.org/10.3988/jcn.2005.1.2.134

Abstract

BACKGROUND AND PURPOSE
The effect of low molecular weight heparin (LMWH) in the management of cerebral venous thrombosis (CVT) remains unclear. The present study was performed to determine the safety and feasibility of subcutaneous LMWH, with particular attention to hemorrhagic conversions.
METHODS
LMWH (nadroparin, 7,500 ICU, every 12 hours) was administered subcutaneously for 14 days to 12 patients diagnosed with CVT. Initial clinical manifestations, etiologies and the clinical courses after LMWH treatment were also evaluated. Possible hemorrhagic side effects, including aggravation of the initial hemorrhage and/or newly developed-hemorrhagic conversions were monitored by image analysis.
RESULTS
Headaches and convulsive movements were frequent presenting symptoms for CVT. Clinical improvement was usually observed within 2 to 8 days after LMWH. Symptom stabilization was observed within 4 to 60 days. Neither clinical aggravations, nor newly developed parenchymal lesions were observed during LMWH maintenance. Associated parenchymal lesions were observed in 9 of the 12 patients, 5 of which manifested with hemorrhagic conversion, as detected by image analysis. However, no clinical and radiologic aggravation was noted in these 5 patients.
CONCLUSIONS
Our results suggest that LMWH may be safe and feasible in the management of CVT.

Keyword

Cerebral venous sinus thrombosis; Low-molecular-weight heparin; Unfractionated heparin

MeSH Terms

Headache
Hemorrhage
Heparin
Heparin, Low-Molecular-Weight*
Humans
Sinus Thrombosis, Intracranial*
Venous Thrombosis
Heparin
Heparin, Low-Molecular-Weight

Figure

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  Figure 1 Case 9. Heparin-induced hemorrhagic conversion on initial and follow-up images. (A) Absence of parenchymal lesion on an initial CT scan, (B) marked thrombi in superior sagittal and straight sinus on initial enhanced T1WI, (C) hemorrhagic conversion on a follow-up non-enhanced CT scan after 2 days of heparin treatment, and (D) remaining encephalomalatic lesion on hemorrhagic converted lesion on a follow-up non-enhanced CT scan 2 months into treatment.

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  Figure 2 Case 3. Hemorrhagic converted venous infarctions on initial and follow-up images. (A) Hemorrhagic infarction in the left temporal lobe on initial image, (B) absence of left lateral sinus on cerebral venography performed after admission, (C) increased surrounding edema without aggravation of initial hemorrhage on follow-up image after 7 days of nadroparin maintenance, and (D) remaining parenchymal destruction on a follow-up T2-weighted axial image, taken a year after treatment.

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