[Extensive cerebral venous thrombosis resistant to heparin: local fibrinolysis with urokinase].
A 37 year-old man had headaches for 10 days, then a single tonic-clonic seizure and coma due to an extensive cerebral venous thrombosis. In spite of full-dose heparin treatment for 7 days, the clinical picture worsened along with increasing edema on CT-Scan. Direct thrombolytic treatment was then performed using transvenous catheterization and instillation of Urokinase (2.6 MU over 4 days). A near complete repermeabilization of the sinuses was obtained and the patient improved dramatically in a few days. The only adverse effect of Urokinase was hematuria. Based on our experience and review of the literature which includes 26 previous cases, direct thrombolytic therapy appears to be a relatively safe procedure. This treatment should be considered in a patient with extensive dural sinus thrombosis which fails to respond to heparin treatment.
Smadja
D
D
Service de Neurologie, CHU Fort-de-France, Martinique.
Raynaud
M
M
Mehdaoui
H
H
Poey
C
C
Drault
J N
JN
Ridarch
A
A
Tixier
F
F
Vernant
J C
JC
Mas
J L
JL
D000328:Adult; D002406:Catheterization, Peripheral; D004351:Drug Resistance; D006493:Heparin; D006801:Humans; D007267:Injections; D002542:Intracranial Embolism and Thrombosis / Q000188:drug therapy*; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage*; D015912:Thrombolytic Therapy; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*
D006493:Heparin; D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator