What would you recommend for long term management of extensive dural venous sinus thrombosis (CVST) in young females when the only provoking risk factor is combined OCP?
Thrombophilia testing, including JAK2 is negative. When would you stop anticoagulation?
Answer from: at Academic Institution
From a Vascular Neurology perspective, there are two considerations when faced with patients with venous sinus thrombosis. First is the status of the intracranial venous circulation and whether or not there has been adequate reconstitution of venous outflow, either through recanalization or collater...
Comments
at UPMC Thanks.
at University of Minnesota Excellent & thorough workup review!
at University of Minnesota 1 year of anticoagulation is fine.
I would anticoagulate initially with a DOAC or warfarin. I would do follow-up imaging in 3-6 months, and if the CVST was significantly improved, switch to aspirin. If not, continue anticoagulation for a total of 12 months, then try discontinuing in favor of aspirin, after reimaging.
In addition to all the above answers:
If there were no other internal risk factors (after a thorough workup for underlying etiologies) except external factors like OCPs then if it is extensive the duration I would pursue would be a total of 12 months of anticoagulation. Also with repeat imaging to ...
Thanks.
Excellent & thorough workup review!
1 year of anticoagulation is fine.
Outstanding answer
Thank you!