Unfractionated or low-molecular weight heparin for the treatment of cerebral venous thrombosis.

BACKGROUND AND PURPOSE: There is no consensus whether to use unfractionated heparin or low-molecular weight heparin for the treatment of cerebral venous thrombosis. We examined the effect on clinical outcome of each type of heparin.

METHODS: A nonrandomized comparison of a prospective cohort study (the International Study on Cerebral Vein and Dural Sinus Thrombosis) of 624 patients with cerebral venous thrombosis. Patients not treated with heparin (n = 107) and those who sequentially received both types of heparin (n = 99) were excluded from the primary analysis. The latter were included in a secondary analysis, allocated according to the type of heparin given first. The primary end point was functional independency at 6 months (modified Rankin scale score ≤ 2). Secondary end points were complete recovery (modified Rankin scale score 0 to 1), mortality, and new intracranial hemorrhages.

RESULTS: A total of 119 patients received low-molecular weight heparin (28%) and 302 received unfractionated heparin (72%). Significantly more patients treated with low-molecular weight heparin were functionally independent after 6 months, both in univariate analysis (odds ratio, 2.1; CI, 1.0 to 4.2) and after adjustment for prognostic factors and imbalances (odds ratio, 2.4; CI, 1.0 to 5.7). In the secondary analysis, there was a similar, nonsignificant trend (odds ratio, 1.7; CI, 0.80 to 3.6). Low-molecular weight heparin was associated with less new intracerebral hemorrhages (adjusted odds ratio, 0.29; CI, 0.07 to 1.3), especially in patients with intracerebral lesions at baseline (adjusted odds ratio, 0.19; CI, 0.04 to 0.99). There was no difference in complete recovery and mortality.

CONCLUSIONS: This nonrandomized study in patients with cerebral venous thrombosis suggests a better efficacy and safety of low-molecular weight heparin over unfractionated heparin. Low-molecular weight heparin seems preferable above unfractionated heparin for the initial treatment of cerebral venous thrombosis.