RSS-Feed abonnieren
DOI: 10.1160/TH10-05-0311
Safety of thrombolysis in cerebral venous thrombosis
A systematic review of the literaturePublikationsverlauf
Received:
21. Mai 2010
Accepted after major revision:
02. Juli 2010
Publikationsdatum:
24. November 2017 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/201005/lookinside/thumbnails/10-1160-th10-05-0311-1.jpg)
Summary
Several small series have suggested the efficacy of thrombolysis in patients with cerebral vein thrombosis (CVT). However, since no randomised controlled trials have compared the use of thrombolysis with anticoagulant treatment in these patients, the risk to benefit ratio of this approach remains uncertain. The aim of this study is therefore to assess the safety of thrombolysis in CVT estimating mortality and major bleeding complications. MEDLINE and EMBASE databases were searched up to June 2010. Two reviewers performed study selection independently. Studies providing data on mortality and/or on the incidence of major bleeding complications were potentially eligible for the study. Two reviewers independently extracted data on study and population characteristics, type, dose and administration route of thrombolytic treatment; use and dose of concomitant heparin. Weighted mean proportion of the mortality rate and of the rate of major and non-major bleeding complications were calculated. Fifteen studies for a total of 156 patients were included. Twelve patients died after thrombolysis (weighted mean 9.2%; 95% CI 4.3, 15.7%) and 15 patients had a major bleeding complication (weighted mean 9.8%; 95% CI 5.3, 15.6%). Twelve haemorrhages were intracranial (weighted mean 7.6%; 95% CI 3.5, 13.1%), and seven of these patients died (58.3%; 95% CI 32.0, 80.7%). Our results suggest that thrombolysis is associated with a nonnegligible incidence of major bleeding complications, including intracranial bleeding potentially affecting patients outcome. Future studies are necessary to evaluate the safety of thrombolysis in comparison to more conservative strategies.
-
References
- 1 Dentali F, Gianni M, Crowther MA. et al. Natural history of cerebral vein thrombosis: a systematic review.. Blood 2006; 108: 1129-1134.
- 2 Ferro JM, Canhão P, Stam J. et al ISCVT Investigators.. Prognosis of cerebral vein and dural sinus thrombosis: results of the International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT).. Stroke 2004; 35: 664-670.
- 3 Einhäupl K, Stam J, Bousser MG. et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients.. Eur J Neurol. 2010 epub ahead of print.
- 4 Smith TP, Higashida RT, Barnwell SL. et al. Treatment of dural sinus thrombosis by urokinase infusion.. AJNR Am J Neuroradiol 1994; 15: 801-807.
- 5 McGinn T, Wyer PC, Newman TB. et al for Evidence-Based Medicine Teaching Tips Working Group. Tips for learners of evidence-based medicine: 3. Measures of observer variability (kappa statistic).. CMAJ 2004; 171: 1369-1373.
- 6 Schulman S, Kearon C. Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.. J Thromb Haemost 2005; 03: 692-694.
- 7 Stam J, Majoie CB, van Delden OM. et al. Endovascular thrombectomy and thrombolysis for severe cerebral sinus thrombosis: a prospective study.. Stroke 2008; 39: 1487-1490.
- 8 Zhang A, Collinson RL, Hurst RW. et al. Rheolytic thrombectomy for cerebral sinus thrombosis.. Neurocrit Care 2008; 09: 17-26.
- 9 Tsai FY, Kostanian V, Rivera M. et al. Cerebral venous congestion as indication for thrombolytic treatment.. Cardiovasc Intervent Radiol 2007; 30: 675-687.
- 10 Soleau SW, Schmidt R, Stevens S. et al. Extensive experience with dural sinus thrombosis.. Neurosurgery 2003; 52: 534-544.
- 11 Wasay M, Bakshi R, Kojan S. et al. Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis.. Stroke 2001; 32: 2310-2317.
- 12 Baker MD, Opatowsky MJ, Wilson JA. et al. Rheolytic catheter and thrombolysis of dural venous sinus thrombosis: a case series.. Neurosurgery 2001; 48: 487-493.
- 13 Philips MF, Bagley LJ, Sinson GP. et al. Endovascular thrombolysis for symptomatic cerebral venous thrombosis.. J Neurosurg 1999; 90: 65-71.
- 14 Frey JL, Muro GJ, McDougall CG. et al. Cerebral venous thrombosis: combined intrathrombus rtPA and intravenous heparin.. Stroke 1999; 30: 489-494.
- 15 Kim SY, Suh JH. Direct endovascular thrombolytic therapy for dural sinus thrombosis: infusion of alteplase.. AJNR Am J Neuroradiol 1997; 18: 639-645.
- 16 Tsai FY, Wang AM, Matovich VB. et al. MR staging of acute dural sinus thrombosis: correlation with venous pressure measurements and implications for treatment and prognosis.. AJNR Am J Neuroradiol 1995; 16: 1021-1029.
- 17 Horowitz M, Purdy P, Unwin H. et al. Treatment of dural sinus thrombosis using selective catheterization and urokinase.. Ann Neurol 1995; 38: 58-67.
- 18 Barnwell SL, Nesbit GM, Clark WM. Local thrombolytic therapy for cerebrovascular disease: current Oregon Health Sciences University experience (July 1991 through April 1995).. J Vasc Interv Radiol 1995; 06 Suppl 78S-82S.
- 19 Di Rocco C, Iannelli A, Leone G. et al. Heparin-urokinase treatment in aseptic dural sinus thrombosis.. Arch Neurol 1981; 38: 431-435.
- 20 Jaillon-Riviere V, Courthéoux P, Defer GL. Place of local thrombolytic therapy in the treatment for cerebral venous thrombosis.. Rev Neurol 2009; 165: 916-923.
- 21 Canhão P, Falcão F, Ferro JM. Thrombolytics for cerebral sinus thrombosis: a systematic review.. Cerebrovasc Dis 2003; 15: 159-166.
- 22 Higgins JP, Thompson SG, Deeks JJ. et al. Measuring inconsistency in meta-analyses.. Br Med J 2003; 327: 557-560.