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.