title: Clinical Outcome of Anticoagulant Treatment in Head or Neck Infection-Associated Cerebral Venous Thrombosis.
abstract: Local infections of the head or neck are a cause of cerebral venous thrombosis. Treatment of infectious cerebral venous thrombosis with heparin is controversial. We examined whether this treatment was associated with intracranial hemorrhagic complications and poor clinical outcome.
  
  
  
  We retrieved data from a prospective cohort study of 624 cerebral venous thrombosis patients. We compared patients with and without an infection of the head or neck and anticoagulated versus not anticoagulated. We examined death or dependency and new intracerebral hemorrhages.
  
  
  
  Six hundred four of 624 patients were eligible for the study. Fifty-seven patients had an infection of the head or neck (9.4%). Comparing data between infection and noninfection patients, the frequency of therapeutic doses of heparin was similar in both groups (82.5% versus 83.7%). New intracerebral hemorrhages were more common in patients with an infection (12.3% versus 5.3%; P=0.04), but death or dependency did not differ between patients with and without an infection (15.8% versus 13.7%). In patients with an infection of the head or neck, there was no significant difference in the frequency of new intracerebral hemorrhages and poor outcome between patients who did or did not receive therapeutic doses of heparin.
  
  
  
  New intracerebral hemorrhages were more frequent in patients with an infection. The use of therapeutic doses of heparin did not seem to influence the risk of new intracranial hemorrhages or poor clinical outcome, but the number of patients who did not receive anticoagulation was too small to draw firm conclusions about safety of heparin in adults with cerebral venous thrombosis and an infection of the head or neck.
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.). s.m.zuurbier@amc.nl.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Zuurbier
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.).
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Coutinho
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.).
authors.forename: Jan
authors.initials: J
authors.lastname: Stam
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.).
authors.forename: Patricia
authors.initials: P
authors.lastname: Canhão
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.).
authors.forename: Fernando
authors.initials: F
authors.lastname: Barinagarrementeria
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.).
authors.forename: Marie-Germaine
authors.initials: MG
authors.lastname: Bousser
authors.affiliation: From the Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands (S.M.Z., J.M.C., J.S.); Department of Neurology, Hospital Santa Maria, Lisboa, Portugal (P.C., J.M.F.); Department of Neurology, Instituto Nacional de Neurologia y Neurocirurgia, México City, Mexico (F.B.); and Department of Neurology, Hôpital Lariboisière, Paris, France (M.-G.B.).
authors.forename: José M
authors.initials: JM
authors.lastname: Ferro
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D002494:Central Nervous System Infections / Q000150:complications*; D005260:Female; D006257:Head / Q000473:pathology; D006493:Heparin / Q000009:adverse effects; D006801:Humans; D007239:Infections / Q000150:complications*; D020300:Intracranial Hemorrhages / Q000139:chemically induced*; D020767:Intracranial Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000473:pathology; D010038:Otorhinolaryngologic Diseases / Q000150:complications*; D017063:Outcome Assessment, Health Care; D012874:Skin Diseases, Infectious / Q000150:complications*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D006493:Heparin
keywords: heparin; infection; intracranial hemorrhages; prospective studies; sinus thrombosis, intracranial