175 Safety of Anticoagulation for the Treatment of Cerebral Venous Sinus Thrombosis in Adult Trauma Patients

INTRODUCTION Cerebral venous sinus thrombosis (CVST) is a potentially devastating neurological outcome of closed head trauma. Current guidelines recommend anticoagulation in adults with spontaneous CVST. Although intracranial hemorrhage resulting from a sinus thrombosis is not considered a contraindication to treatment, less is known regarding the treatment of CVST in patients with acute traumatic brain injury, who often have intracranial hemorrhages unrelated to the thrombosis. METHODS A prospectively collected database at a level 1 trauma center was retrospectively reviewed. Demographic, clinical, radiographic, and follow-up data were collected for adult patients with one or more skull fractures in the setting of blunt trauma who underwent venous imaging. Patients admitted from January 2004 through December 2013 were included. RESULTS Of 541 patients with skull fractures, 113 (21%) patients underwent venous imaging to assess the patency of the venous sinuses. Fifty-six (49%) of these patients had no evidence of venous sinus injury, whereas 38 (34%) were found to have a CVST, and an additional 19 (17%) had external compression of a sinus by an extra-axial hemorrhage. Of the 38 patients with CVST, 22 (58%) patients were treated with anticoagulation. The mean duration of anticoagulation was 3.35 months (range 0.07-8.57 months). The thrombosis resolved by 3 months in 11 (50%) patients, and was stable at 6 months in 3 (14%) patients. Three (14%) patients developed minor complications (eg, gastrointestinal bleeding), whereas an additional 3 (14%) patients developed new or worsening intracranial hemorrhage, resulting in 1 mortality. CONCLUSION Skull fractures resulting from blunt trauma should prompt a high index of suspicion for underlying venous sinus pathology. However, it is important to distinguish between intrinsic CVST and external sinus compression by an extra-axial hemorrhage. In cases of CVST, patients on anticoagulation must be monitored closely and undergo repeat imaging to rule out new or worsening intracranial hemorrhage.