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Local thrombolysis in patients with dural venous thrombosis unresponsive to heparin.

Sujith OK, Krishnan R, Asraf V, Rahman A, Girija AS

University of British Columbia, Vancouver, British Columbia, Canada. sujith@interchange.ubc.ca

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. CONCLUSION: 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.

Published 18 March 2008 in J Stroke Cerebrovasc Dis, 17(2): 95-100.
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