Summary
Several small series have suggested the efficacy of thrombolysis in patients with
cerebral vein thrombosis (CVT). However, since no randomised controlled trials have
compared the use of thrombolysis with anticoagulant treatment in these patients, the
risk to benefit ratio of this approach remains uncertain. The aim of this study is
therefore to assess the safety of thrombolysis in CVT estimating mortality and major
bleeding complications. MEDLINE and EMBASE databases were searched up to June 2010.
Two reviewers performed study selection independently. Studies providing data on mortality
and/or on the incidence of major bleeding complications were potentially eligible
for the study. Two reviewers independently extracted data on study and population
characteristics, type, dose and administration route of thrombolytic treatment; use
and dose of concomitant heparin. Weighted mean proportion of the mortality rate and
of the rate of major and non-major bleeding complications were calculated. Fifteen
studies for a total of 156 patients were included. Twelve patients died after thrombolysis
(weighted mean 9.2%; 95% CI 4.3, 15.7%) and 15 patients had a major bleeding complication
(weighted mean 9.8%; 95% CI 5.3, 15.6%). Twelve haemorrhages were intracranial (weighted
mean 7.6%; 95% CI 3.5, 13.1%), and seven of these patients died (58.3%; 95% CI 32.0,
80.7%). Our results suggest that thrombolysis is associated with a nonnegligible incidence
of major bleeding complications, including intracranial bleeding potentially affecting
patients outcome. Future studies are necessary to evaluate the safety of thrombolysis
in comparison to more conservative strategies.
Keywords
Cerebral vein thrombosis - thrombolysis
