Abstract
Background
Treatment of cerebral sinus thrombosis with thrombolytics has been reported in cases with a deteriorating clinical course despite anticoagulant therapy. The rationale of this treatment is to promote rapid recanalisation of the occluded sinus.
Objectives
To review the available evidence on the efficacy and safety of thrombolysis in confirmed cerebral sinus thrombosis.
Search methods
We searched the Cochrane Stroke Group trials register (March 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003), MEDLINE (1966 to March 2003), EMBASE (1980 to March 2003), and reference lists of all relevant publications.
Selection criteria
We aimed to analyse separately unconfounded randomised controlled trials comparing thrombolytic agent with placebo, or thrombolytic agent with antithrombotic therapy, or thrombolytic agent and antithrombotic with antithrombotic alone, in patients with dural sinus thrombosis (confirmed by MR venography, intra-arterial venography or CT venography).
Data collection and analysis
Two groups of reviewers independently applied the inclusion criteria.
Main results
No randomised controlled trials were found.
Authors’ conclusions
There is currently no available evidence from randomised controlled trials regarding the efficacy or safety of thrombolytic therapy in dural sinus thrombosis. A randomised controlled trial is justified to test this therapy especially in patients predicted to have a poor prognosis.
Plain language summary
Thrombolysis for cerebral vein and dural sinus thrombosis
There is no good evidence on the effects of thrombolysis for cerebral vein thrombosis. Blood drains from the brain into the cerebral veins and then into the cerebral venous sinuses. If a clot forms in one of these blood vessels, it can cause headaches, seizures, loss of consciousness and other neurological symptoms. Clot dissolving treatments (thrombolytic therapy) could help to clear the clot and improve the patients’ condition. However, thrombolytic therapy can cause serious or even fatal bleeding in the brain. The reviewers did not find any reliable evidence from randomised trials about the balance of risk and benefit from this treatment. Randomised controlled trials of this treatment are needed.
