CSVT Prophylaxis and Treatment
The standard CSVT treatment in our organization comprises of low molecular weight heparin (LMWH). 1st choice is Enoxaparin with a dose of 1 mg/kg twice daily administered subcutaneously. We aim for therapeutic target of anti-Xa activity level that ranges between 0.5 and 1 IU/ml, and we stop treatment after a minimal period of 3 months when CT scan or brain MRI shows complete resolution or significant improvement of the filling defect. Treatment is halted for 24 hours pre and 6 hours post some procedures such as lumbar puncture.
For primary prophylaxis, we didn’t utilize anticoagulation treatment. Neither antithrombin replacement was given for low antithrombin (AT) levels nor fresh frozen plasma were provided when fibrinogen levels were low.
Anticoagulation was given for at least 3 months and until radiological resolution is achieved. It was continued as well throughout the ASP therapy. Therapy was modified in case of CSVT; for low risk patients, dexamethasone was omitted in the third week of each reinduction, and asparaginase was omitted from the first week of each reinduction. In intermediate and high-risk patients, dexamethasone was omitted from weeks 4 and 9 and low molecular weight heparin was given during the first 19 weeks of continuation.
LMWH was continued till all asparaginase doses were received even if it entailed prolonging anticoagulation for more than 3 months.