Background: Cerebral venous sinus thrombosis (CVST) accounts for <1% of all strokes. Prior studies have demonstrated that anticoagulation in CVST is safe and reduces adverse events.

Aims: The objective of our study was to characterize the clinical features, identify the timing and duration of anticoagulation therapy, and establish the outcomes of patients diagnosed with CVST.

Methods: Using ICD-9 and ICD-10 codes, we conducted a retrospective chart review of patients admitted to Hamilton Health Sciences (HHS) from 2015 to 2020 with CVST confirmed on imaging.

Results: We included 96 patients (57 females; 39 males), mean age of 47.9 (SD 18.1). The most common clinical presentation was headache (43.8%). Trauma was the most common identified risk factor (15.6%), followed by oral contraceptive use (8.3%) and infection (8.3%). A cause was not identified in 27% of individuals. Most patients (57.3%) received full dose anticoagulation within 24hrs of identified CVST diagnosis. Reasons for delay in anticoagulation included the presence of venous infarct or haemorrhage (27.1%), traumatic brain injury (31.8%), post-op from neurosurgery (9.1%), but in 31.8% of patients there was no clear rationale. Moreover, there was a greater proportion of patients disabled (modified Rankin Scale, mRS, score > 2) and dead (mRS 6) at discharge with a delay in initiating anticoagulation (72%) compared to those who received anticoagulation within 24hr (40%) of identified CVST. The majority of patients (55%) had greater than 12 months to ongoing follow-up. The recurrence rate for CVST was 2.5%, while bleeding complications during anticoagulation therapy was 6.3%, all of which did not require hospitalization.

Conclusions: Our findings suggest that unjustified delay in anticoagulation may result in poorer clinical outcomes, however further studies are needed to confirm our findings and investigate whether prompt start of anticoagulation improves outcomes in CVST.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/single-centre-retrospective-chart-review-to-examine-the-management-of-timing-of-anticoagulation-and-outcomes-in-patients-with-cerebral-venous-sinus-thrombosis/