Abhishek Chaturbedi and Jitendra Thakur
Background: Cerebral venous sinus thrombosis (CVST) is a rare form of stroke which still carries significant morbidity and mortality. Previous treatment regimen pertained to primarily medical therapies, with use of anticoagulants like Coumadin and Heparin. However the advent of Direct Thrombin Inhibitors (DTI) which do not need regular monitoring of blood coagulation panel and has better safety profile than Coumadin, has been suggested as a treatment modality for CVST in recent literature.
Case Description: It is a case series of 7 adult patients presenting with intracerebral hemorrhage secondary to CVST from occlusion of dural venous sinuses. Dabigatran, a DTI was used as the primary treatment modality for a period of 6 months for 5 patients who had identifiable underlying cause and lifelong for 2 patient who had no identifiable underlying cause for dural sinus thrombosis. Patients has been followed for a total period of six months while on DTI treatment, with Magnetic Resonance Venography (MRV) of the brain performed at 6 months follow up visit to assess recanalization of the obstructed dural sinuses. All the 7 patients had improved clinical outcome at 6 months follow up visit with no added morbidity upon using DTI. Five patients had complete recanalization of obstructed venous sinuses, while 2 patient had partial recanalization at 6 months follow-up visit. No patient had increased hematoma volume while on treatment with DTI.
Conclusion: This case series suggests DTI are probably effective primary treatment modality for patients with CVST with good safety profile.