Special indications for vitamin K antagonists: a review

[Thrombosis of the cerebral veins in gynecological practice]

The review presents literature data on the risk factors of cerebral venous thrombosis (CVT), a rare life threatening disorder. Currently, the diagnosis of CVT is made more often due to the possibility of using neuroimaging methods of cerebral structures. Pregnancy, postpartum period, use of oral contraceptives are risk factors of CVT. A role of thrombophilia, in particular Factor V Leiden mutations and the prothrombin G20210A polymorphism, in the CVT pathogenesis is confirmed. The development of CVT is an example of the interaction between persistent risk factors increasing the likelihood of thrombotic complications and acquired risk factors. A focal neurological deficit during pregnancy, delivery and postpartum period is the best indicator of CVT diagnosis. Possibilities of the use of anticoagulants in treatment and prevention of CVT are analyzed.

Cerebral vein thrombosis

The estimated annual incidence of cerebral vein thrombosis (CVT) is 3 to 4 cases per million in adults and 7 cases per million in neonates. Among the commonest risk factors there are oral contraceptive use, pregnancy and puerperium that make CVT more frequent in women than in men. Cerebral tumors, infections and traumas are less encountered local risk factors. In 15-20% of patients CVT remains unprovoked. Coagulation abnormalities causing thrombophilia, as well as hyperhomocysteinemia, are worthy to be investigated in patients with CVT. Rarely CVT can be the first clinical manifestation of a myeloproliferative neoplasm. The recurrence rate of CVT is low, but venous thromboembolism in the common sites (lower-limb deep vein thrombosis or pulmonary embolism) can recur, particularly in patients with a first idiopathic CVT. Early diagnosis and anticoagulant treatment reduce morbidity of CVT and improve survival, although the optimal duration of anticoagulant treatment is not well established.

Cerebral sinus-venous thrombosis

Cerebral sinus-venous thrombosis (CSVT) is a rare life-threatening disease with an estimated annual incidence of 3-4 cases per million in adults and 7 cases per million in neonates. Brain tumors, cerebral infections and traumas are local risk factors for CSVT, but the commonest encountered risk factors are oral contraceptive use, pregnancy and puerperium that make the disease predominant in female sex. In 15-20 % of patients, the disease remains unprovoked, i.e., occurring in the absence of predisposing factors. Thrombophilic abnormalities either inherited [deficiency of the natural anticoagulant proteins antithrombin, protein C or protein S, mutations in the factor V gene (factor V Leiden) or prothrombin gene (prothrombin G20210A)] or acquired (antiphospholipid antibodies) are worthy to be investigated in patients with CSVT, as well as hyperhomocysteinemia. In a small proportion of patients, CSVT is the first manifestation of a myeloproliferative neoplasm. The proportion of patients with recurrent CSVT is low, but venous thromboembolism (deep vein thrombosis in the lower limbs or pulmonary embolism) can develop particularly in patients with a first idiopathic CSVT. In the past decade, there has been increasing evidence that early diagnosis and anticoagulant treatment reduce morbidity of CSVT and improve survival. However, the optimal duration of anticoagulant treatment is not well established, because limited information is available on the rate of CSVT recurrence after anticoagulant discontinuation.