Local thrombolysis in patients with dural venous thrombosis unresponsive to heparin.
OBJECTIVE
We sought to study the efficacy and complications of local thrombolysis using urokinase in cases of cortical vein thrombosis unresponsive to conventional heparin therapy.


METHODS
Patients with clinical and radiologic diagnosis of cortical vein thrombosis were taken for local thrombolysis using femoral vein approach if they did not respond to heparin therapy after 5 days of administration of the drug. Urokinase was used as the thrombolytic agent and dose was decided depending on the recanalization obtained during the procedure.


RESULTS
Of the 3 patients treated, two had complete recanalization and one had partial recanalization. Two had dramatic recovery of the clinical symptoms. One patient in whom thrombolysis was delayed had partial recovery. None had any complications related to the treatment.


CONCLUSIONS
Local thrombolytic therapy is effective in recanalization of thrombosed sinus. It is worth considering in dire circumstances especially when a patient fails to respond to heparin. However, randomized controlled trials are necessary before any firm recommendations can be made as to whether it can be used as a primary modality of treatment in cases of cortical vein thrombosis.
Sujith
O K
OK
University of British Columbia, Vancouver, British Columbia, Canada. sujith@interchange.ubc.ca
Krishnan
Rama
R
Asraf
V
V
Rahman
Abdu
A
Girija
A S
AS
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use*; D002533:Cerebral Angiography / Q000379:methods; D004388:Dura Mater / Q000098:blood supply*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006493:Heparin / Q000627:therapeutic use*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D018579:Patient Selection; D010690:Phlebography; D012851:Sinus Thrombosis, Intracranial / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator