Are anticoagulants indicated for the treatment of cavernous sinus thrombosis (CST)?

Updated: Jul 16, 2018
  • Author: Rahul Sharma, MD, MBA, FACEP; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Controversy exists on the use of anticoagulation for cavernous sinus thrombosis. Because of the rarity of this syndrome, no prospective trials have been performed on the use of anticoagulation for CST. Some retrospective studies have shown a decrease in mortality and clot propagation by anticoagulation. A Cochrane review found two small trials involving 79 patients who were treated with anticoagulants. Limited evidence suggests anticoagulant drugs are probably safe and may be beneficial for people with sinus thrombosis. [9] Therefore, anticoagulation with heparin should be considered since the goal is to prevent further thrombosis and to reduce the incidence of septic emboli. One review suggests that low-molecular weight heparin (LMWH) is superior to unfractionated heparin (UFH). [10] Heparin is contraindicated in the presence of intracerebral hemorrhage or other bleeding diathesis.


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