AHA/ASA guideline recommendations for prevention of stroke in women cerebral venous thrombosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ayokunle Olubaniyi, M.B,B.S [2]

2014 AHA/ASA Guideline Recommendations for Prevention of Stroke in Women (DO NOT EDIT)[1]

Class I
"1. In patients with suspected cerebral venous thrombosis, routine blood studies consisting of a complete blood count, chemistry panel, prothrombin time, and activated partial thromboplastin time should be performed. (Level of Evidence: C) "
"2. Screening for potential prothrombotic conditions that may predispose a person to cerebral venous thrombosis (eg, use of contraceptives, underlying inflammatory disease, infectious process) is recommended in the initial clinical assessment. (Level of Evidence: C ) "
"3. For women with cerebral venous thrombosis during pregnancy, LMWH in full anticoagulant doses should be continued throughout pregnancy, and LMWH or vitamin K antagonist with a target international normalized ratio of 2.0 to 3.0 should be continued for ≥6 weeks post partum (for a total minimum duration of therapy of 6 months). (Level of Evidence: C ) "
Class IIa
"1. Testing for prothrombotic conditions, including protein C, protein S, or antithrombin deficiency; antiphospholipid syndrome; prothrombin G20210A mutation; and factor V Leiden can be beneficial for the management of patients with CVT. Testing for protein C, protein S, and antithrombin deficiency is generally indicated 2 to 4 weeks after completion of anticoagulation. There is a very limited value of testing in the acute setting or in patients taking warfarin. (Level of Evidence: B) "
"2. It is reasonable to advise women with a history of CVT that future pregnancy is not contraindicated. Further investigations regarding the underlying cause and a formal consultation with a hematologist or maternal fetal medicine specialist are reasonable. (Level of Evidence: B) "
"3. It is reasonable to treat acute CVT during pregnancy with full-dose LMWH rather than unfractionated heparin. (Level of Evidence: C) "
"4. For women with a history of CVT, prophylaxis with LMWH during future pregnancies and the postpartum period is reasonable. (Level of Evidence: C) "
Class IIb
"1. In patients with provoked CVT (associated with a transient risk factor), vitamin K antagonists may be continued for 3 to 6 months, with a target international normalized ratio of 2.0 to 3.0. (Level of Evidence: C)"
"2. In patients with unprovoked CVT, vitamin K antagonists may be continued for 6 to 12 months, with a target international normalized ratio of 2.0 to 3.0. (Level of Evidence: C) "
"3. For patients with recurrent CVT, VTE after CVT, or first CVT with severe thrombophilia (ie, homozygous prothrombin G20210A; homozygous factor V Leiden; deficiencies of protein C, protein S, or antithrombin; combined thrombophilia defects; or antiphospholipid syndrome), indefinite anticoagulation may be considered, with a target international normalized ratio of 2.0 to 3.0. (Level of Evidence: C) "

References

  1. Bushnell C, McCullough LD, Awad IA, Chireau MV, Fedder WN, Furie KL; et al. (2014). "Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association". Stroke. doi:10.1161/01.str.0000442009.06663.48. PMID 24503673.


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