Safety of anticoagulation for cerebral venous thrombosis associated with intracerebral hematoma.

Abstract

Intracerebral hemorrhage (ICH) occurs in 25 to 50% of cases of cerebral venous thrombosis (CVT).1,2⇓ Although there is increasing evidence that treatment with heparin remains safe and is appropriate in patients with hemorrhagic venous infarction,1,2⇓ some uncertainties remain about the use of anticoagulation for CVT in the presence of large intracerebral hemorrhages or hemorrhages located in the temporal lobe.3 The size of intracerebral hemorrhage (ICH) in CVT can range from trivial to massive. However, indication of the volume of ICH has been rare in previously published studies of CVT.3,4⇓ When CVT is treated with combined intrathrombus tissue plasminogen activator (tPA) and IV heparin, the risk of recurrent ICH is greater for patients with large ICH compared with those with small or subtle hemorrhages.4 It is not known whether treatment with IV heparin alone is associated with a similar increase in hemorrhage risk for patients with large ICH. We present a series of patients with CVT that …