See related article, p 8. Evidence relating to efficacy and safety of anticoagulants for CVT is only partially available from studies in the peer reviewed medical literature and from the corresponding authors of those studies. Consequently, this article is an opinion piece rather than a systematic review. Cerebral venous thrombosis (CVT) accounts for ≈0.5% of strokes and may occur at any age.1 Risk factors include pregnancy, oral contraceptives, head trauma, malignancy, infection, anemia, and dehydration. In older reports, the incidence of CVT was 3 to 4 per 1 million people per year in Europe and the United States.2 However, a survey published in 2012 found an incidence of CVT of 13.2 per 1 million people per year.3 With modern brain imaging technology, more cases are being discovered that probably would have resolved without medical intervention. Relative to pre-1990 clinical outcomes data, the average prognosis has dramatically improved.4,5 A Cochrane review of anticoagulant therapy for CVT4 based the recommendation in favor of using anticoagulation treatment (full-dose unfractionated heparin [UFH] or low-molecular-weight heparin [LMWH] followed by a vitamin K antagonist [VKA]) on 2 small randomized placebo-controlled trials (RCTs, n=79). These trials demonstrated a non-statistically significant reduction in deaths with anticoagulation (risk ratio, 0.33; 95% confidence interval [CI], 0.08–1.28). Subsequently, the European Federation of Neurological Sciences6 and the American Heart Association/American Stroke Association7 issued clinical practice guidelines calling for full-dose heparin acutely followed by VKAs for ≥3 months. The efficacy and safety of anticoagulants for CVT have not been comprehensively reviewed, with the inclusion of observational studies and the RCTs excluded from the Cochrane review. This review will evaluate published reports from 1990 to 2013 regarding the efficacy and safety of full-dose heparin (UFH or LMWH) during initial hospitalization and subsequent VKA treatment …