Are steroids useful to treat cerebral venous thrombosis?
OBJECTIVE
No randomized controlled trial has evaluated the efficacy of steroids in acute cerebral venous thrombosis (CVT). We aimed to analyze the effect of steroids on the outcome of patients in the International Study on Cerebral Veins and Dural Sinus Thrombosis (ISCVT).


METHODS
ISCVT is a prospective observational study that included 624 CVT patients. Death or dependence at 6 months was compared between cases (patients treated with steroids) and controls (patients not treated with steroids), using 3 designs: (1) Matched case-control study (each case matched with a control for prognostic factors); (2) Nonmatched case-control study of the ISCVT cohort; (3) Case-control study in different strata according to the number of poor prognostic variables in each patient.


RESULTS
One hundred and fifty (24%) patients were treated with steroids. (1) In the matched case-control study, poor outcome was similar in the two groups of patients (26/146 versus 17/149, OR=1.7; 95% CI 0.9 to 3.3, P=0.119). (2) In the ISCVT cohort, no significant difference in poor outcomes was found whether patients were treated with steroids or not (26/146 versus 60/469, OR=1.5; 95% CI 0.9 to 2.4). Patients without parenchymal lesions treated with steroids had worse prognosis than those treated without steroids (8/45 versus 9/184, OR=4.2, 95% CI 1.6 to 11.6, P=0.008). (3) Treatment with steroids was not associated with a better outcome in any strata of patients according to the number of poor prognostic factors.


CONCLUSIONS
Steroids in the acute phase of CVT were not useful and were detrimental in patients without parenchymal cerebral lesions. These results do not support the use of steroids in CVT (evidence level III).
Department of Clinical Neurosciences and Mental Health, Hospital Santa Maria, 1649-035 Lisbon, Portugal. pcanhao@fm.ul.pt
Patrícia
P
Canhão
Ana
A
Cortesão
Marta
M
Cabral
José M
JM
Ferro
Jan
J
Stam
Marie-Germaine
MG
Bousser
Fernando
F
Barinagarrementeria
D000328:Adult; D016022:Case-Control Studies; D002550:Cerebral Veins / Q000473:pathology; D005260:Female; D006801:Humans; D007391:International Cooperation; D020767:Intracranial Thrombosis / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D011379:Prognosis; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use*; D016896:Treatment Outcome
D013256:Steroids