BACKGROUND: Anticoagulation is the mainstay acute therapy for cerebral venous thrombosis (CVT). Decompressive surgery is required in a small minority of patients with large parenchymal lesions and impending herniation, which requires a temporary suspension of anticoagulation. AIMS: The objective of this study was to identify the optimal timing for starting or resuming anticoagulation following decompressive surgery. METHODS: Data were collected from the Decompressive Surgery for CVT Study 2 (DECOMPRESS2), a prospective multinational cohort observational study of 118 patients with severe CVT treated by decompressive surgery. We assessed the frequency of new hemorrhagic and of venous thrombotic events from admission to discharge in patients who started or resumed anticoagulation 2) at discharge and at one year follow up and compared between the two groups. RESULTS: f the 90 patients available for analysis, 35 (39%) started or resumed anticoagulation within the first 24 hours after surgery while 55 (61%) did so later than 24 hours. Overall frequency of patients with new hemorrhagic or venous thrombotic events from admission to discharge was 26.7% (24 patients), without crude or adjusted for the propensity score statistically significant difference between the early and late anticoagulation groups (<24h, 11 patients, 31%, vs ≥24h, 13 patients, 24%; OR 0.86; 95% CI 0.24 to 3.04;.X2= 0.33, p= 0.57). The distribution of major hemorrhagic events was also comparable: 8 (23%) bleedings in the <24 hours, and 9 (16%) in the ≥24 hours ((X2= 0.24, p= 0.62). No CVT recurred. Two venous thrombotic events occurred in <24h (6%) and 5 in the ≥24h (9%) group.
There was no association between anticoagulation timing and death or dependence (mRS 3-6) at discharge (OR 1.65. 95% CI 0.30 to 9.01, p=0.56), or at one year follow up (OR 2.19, 95% CI 0.78 to 6.10, p=0.14). CONCLUSIONS
