🧠 Cerebral Venous Sinus Thrombosis (CVST) Management
UseManagement framing of cerebral venous sinus thrombosis.
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SourceSaposnik G, et al. AHA/ASA Scientific Statement on Cerebral Venous Thrombosis / ESO Guideline on CV…
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
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This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋Stroke codeOpen scene pack →Matching pathway
🧭strokeOpen pathway →Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
Anticoagulation is the cornerstone even when a hemorrhagic infarct is present — the hemorrhage is from venous congestion and anticoagulation is proven safe.
When to use
Management framing of cerebral venous sinus thrombosis.
How it works
Acute phase → therapeutic anticoagulation with LMWH (preferred over unfractionated), given even with hemorrhagic venous infarction. duration per current guidelines; recurrent/thrombophilia/cancer long-term. Deterioration despite full anticoagulation → endovascular therapy; herniation → decompressive craniectomy.
Key points
- Anticoagulation is the cornerstone even when a hemorrhagic infarct is present — the hemorrhage is from venous congestion and anticoagulation is proven safe.
- warfarin is preferred in antiphospholipid syndrome / active cancer / renal impairment.
- Manage raised ICP (acetazolamide, lumbar drainage/shunt for vision-threatening isolated intracranial hypertension) and seizures; steroids are not routinely used.
- Find and treat the trigger; women with prior CVST should avoid estrogen-progestin contraception.
References
- [Guideline / primary source]Saposnik G, et al. AHA/ASA Scientific Statement on Cerebral Venous Thrombosis / ESO Guideline on CVST 2017
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Concomitant hemorrhagic venous infarction | Yes |
|---|---|
| Progressive deterioration despite full anticoagulation / herniation | Yes |
→ActionAnticoagulation + endovascular/decompression assessment
- Anticoagulation (cornerstone)：Acute-phase therapeutic anticoagulation — low-molecular-weight heparin (preferred over unfractionated; use unfractionated in renal impairment or when urgent reversal/surgery may be needed); anticoagulate even with concomitant hemorrhagic venous infarction (CVST hemorrhage arises from venous congestion, so anticoagulation is the foundational treatment and is proven safe in randomised trials)
- Subsequent oral therapy：duration — provoked, unprovoked, recurrent or definite thrombophilia/active cancer long-term; warfarin preferred in antiphospholipid syndrome/active cancer/renal impairment
- Progression/herniation：Severe cases with progressive deterioration despite full anticoagulation: consider endovascular therapy (mechanical thrombectomy/local thrombolysis; TO-ACT did not show a routine mortality benefit); parenchymal lesion with herniation → decompressive craniectomy as a life-saving measure
| Concomitant hemorrhagic venous infarction | No |
|---|---|
| Progressive deterioration despite full anticoagulation / herniation | No |
→ActionTherapeutic-dose anticoagulation
- Anticoagulation (cornerstone)：Acute-phase therapeutic anticoagulation — low-molecular-weight heparin (preferred over unfractionated; use unfractionated in renal impairment or when urgent reversal/surgery may be needed); anticoagulation is likewise the basis in patients without hemorrhage
- Subsequent oral therapy：duration — provoked, unprovoked, recurrent or definite thrombophilia/active cancer long-term; warfarin preferred in antiphospholipid syndrome/active cancer/renal impairment
- Symptomatic：Raised intracranial pressure: acetazolamide, and if needed lumbar drainage or shunt (for isolated intracranial hypertension threatening vision); seizures: antiseizure drugs for supratentorial lesions or clinical seizures (not prophylactic); steroids not recommended (unless a concomitant inflammatory disease)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Cerebral Venous Sinus Thrombosis (CVST) Management?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Cerebral Venous Sinus Thrombosis (CVST) Management upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Cerebral Venous Sinus Thrombosis (CVST) Management calculated in practice? Can you show a worked example?
- Inputs: Concomitant hemorrhagic venous infarction Yes, Progressive deterioration despite full anticoagulation / herniation Yes → Result: Action Anticoagulation + endovascular/decompression assessment（Anticoagulation (cornerstone): Acute-phase therapeutic anticoagulation — low-molecular-weight heparin (preferred over unfractionated; use unfractionated in renal impairment or when urgent reversal/surgery may be needed); anticoagulate even with concomitant hemorrhagic venous infarction (CVST hemorrhage arises from venous congestion, so anticoagulation is the foundational treatment and is proven safe in randomised trials), Subsequent oral therapy: duration — provoked, unprovoked, recurrent or definite thrombophilia/active cancer long-term; warfarin preferred in antiphospholipid syndrome/active cancer/renal impairment, Progression/herniation: Severe cases with progressive deterioration despite full anticoagulation: consider endovascular therapy (mechanical thrombectomy/local thrombolysis; TO-ACT did not show a routine mortality benefit); parenchymal lesion with herniation → decompressive craniectomy as a life-saving measure） Inputs: Concomitant hemorrhagic venous infarction No, Progressive deterioration despite full anticoagulation / herniation No → Result: Action Therapeutic-dose anticoagulation（Anticoagulation (cornerstone): Acute-phase therapeutic anticoagulation — low-molecular-weight heparin (preferred over unfractionated; use unfractionated in renal impairment or when urgent reversal/surgery may be needed); anticoagulation is likewise the basis in patients without hemorrhage, Subsequent oral therapy: duration — provoked, unprovoked, recurrent or definite thrombophilia/active cancer long-term; warfarin preferred in antiphospholipid syndrome/active cancer/renal impairment, Symptomatic: Raised intracranial pressure: acetazolamide, and if needed lumbar drainage or shunt (for isolated intracranial hypertension threatening vision); seizures: antiseizure drugs for supratentorial lesions or clinical seizures (not prophylactic); steroids not recommended (unless a concomitant inflammatory disease)）