European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - Endorsed by the European Academy of Neurology
European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - Endorsed by the European Academy of Neurology
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DOI：
10.1177/2396987317719364
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发表时间：
2017-09-01
影响因子：
6.1
通讯作者：
Stam, Jan
中科院分区：
文献类型：
--
作者：
Ferro, Jose M.;Bousser, Marie-Germaine;Stam, Jan
目前关于脑静脉血栓形成指南的建议遵循建议、评估、发展和评估系统的分级，制定相关的诊断和治疗问题，对所有现有证据进行系统审查，并根据现有科学证据的质量，以明确和透明的方式确定建议的强度。该指南涉及诊断和治疗两个主题。我们建议使用磁共振或CT血管成像来确认脑静脉血栓形成的诊断，而不是常规地对脑静脉血栓形成患者进行血栓形成或癌症的筛查。我们建议在急性脑静脉血栓形成时采用肠外抗凝和减压手术，以防止因脑突出而导致的死亡。我们建议在急性期优先使用低分子肝素，不使用直接口服抗凝剂。我们建议不要使用类固醇和乙酰唑胺来减少死亡或依赖。我们建议对有早期癫痫发作和幕上病变的患者使用抗癫痫药物，以防止进一步的早期癫痫发作。由于急性期后的抗凝持续时间、溶栓和/或取栓、治疗性腰椎穿刺术以及抗癫痫药物预防远程癫痫发作的证据质量非常差，我们无法提出建议。我们建议，对于有脑静脉血栓形成史的女性，应避免使用含有雌激素的避孕药。我们建议后续妊娠是安全的，但在整个妊娠和产褥期应考虑预防性使用低分子肝素。需要进行多中心的观察和实验研究，以增加支持脑静脉血栓诊断和治疗建议的证据水平。
The current proposal for cerebral venous thrombosis guideline followed the Grading of Recommendations, Assessment, Development, and Evaluation system, formulating relevant diagnostic and treatment questions, performing systematic reviews of all available evidence and writing recommendations and deciding on their strength on an explicit and transparent manner, based on the quality of available scientific evidence. The guideline addresses both diagnostic and therapeutic topics. We suggest using magnetic resonance or computed tomography angiography for confirming the diagnosis of cerebral venous thrombosis and not screening patients with cerebral venous thrombosis routinely for thrombophilia or cancer. We recommend parenteral anticoagulation in acute cerebral venous thrombosis and decompressive surgery to prevent death due to brain herniation. We suggest to use preferentially low-molecular weight heparin in the acute phase and not using direct oral anticoagulants. We suggest not using steroids and acetazolamide to reduce death or dependency. We suggest using antiepileptics in patients with an early seizure and supratentorial lesions to prevent further early seizures. We could not make recommendations due to very poor quality of evidence concerning duration of anticoagulation after the acute phase, thrombolysis and/or thrombectomy, therapeutic lumbar puncture, and prevention of remote seizures with antiepileptic drugs. We suggest that in women who suffered a previous cerebral venous thrombosis, contraceptives containing oestrogens should be avoided. We suggest that subsequent pregnancies are safe, but use of prophylactic low-molecular weight heparin should be considered throughout pregnancy and puerperium. Multicentre observational and experimental studies are needed to increase the level of evidence supporting recommendations on the diagnosis and management of cerebral venous thrombosis.