Source of Support: None, Conflict of Interest: None
Cerebral venous thrombosis accounts for 10-20% of strokes in the young in India. Over the past decade, heparin has become the mainstay of treatment of cerebral venous thrombosis. The conventional doses of heparin require strict monitoring of activated partial thromboplastin time. Efficacy of low doses of heparin in cerebral venous thrombosis has already been studied. Objective: The present study compared the low dose heparin to medium dose of heparin in cerebral venous thrombosis. Methods: A prospective, randomized controlled study including consecutive patients was conducted in the department of Neurology, a tertiary referral center in India from 1996 to 1998. Patients with cerebral venous thrombosis confirmed clinically and by neuroimaging were randomized to receive low dose (2500 units TID) or medium dose (5000 units TID) heparin. All patients were assessed periodically until discharge or death. Outcome was assessed using modified Rankin scale (good outcome <3, poor outcome 3 3). Patients who deteriorated without increase of hemorrhage or developed deep venous thrombosis were given higher doses of heparin. Results: Twenty-nine patients were randomized into each group. There was no increase or additional hemorrhage in either group. Five patients in the low dose group required increase in heparin dose (to 5000 units TID) due to deterioration. Good outcome was seen in 89% on medium dose and 44.8% on low dose heparin (p<0.05). Conclusions: the randomized controlled trial from an Indian center demonstrated that medium dose regimen of heparin is better than low dose regimen and also safe in the treatment of cerebral venous thrombosis.