What initial management steps should I take for a patient diagnosed with CVST, including anticoagulation considerations?

Initial management of a patient diagnosed with cerebral venous sinus thrombosis (CVST) involves prompt initiation of full-dose anticoagulation therapy, even in the presence of secondary cerebral haemorrhage, unless contraindications exist. The recommended anticoagulation is initially with full-dose heparin (usually low molecular weight heparin) followed by oral anticoagulation with warfarin targeting an international normalised ratio (INR) of 2 to 3. This approach aims to prevent thrombus propagation and facilitate recanalisation of the affected venous sinuses ¹,².

Assessment for contraindications to anticoagulation, such as significant comorbidities or bleeding risk, is essential before starting treatment. If anticoagulation is contraindicated, alternative mechanical interventions may be considered, although these are less commonly used ¹.

During anticoagulation, close monitoring is required to balance the risk of bleeding against the benefits of preventing further thrombosis. In cases where direct oral anticoagulants (DOACs) are considered unsuitable, the standard regimen remains low molecular weight heparin followed by vitamin K antagonists ¹.

Additional supportive care includes managing intracranial pressure, seizures, and any underlying causes or risk factors for CVST. Early involvement of neurology or stroke specialists is recommended to guide comprehensive management ¹[(Fan et al., 2020)].