Characteristics and outcomes of postpartum cerebral venous sinus thrombosis: A subgroup analysis of the ACTION-CVT study


      Background and purpose

      There is a relative paucity of data regarding long-term outcomes and treatment-related complications in women of childbearing age with cerebral venous sinus thrombosis (CVST). We sought to determine whether outcomes differ in women of childbearing age with versus without postpartum CVST.


      We retrospectively analysed 373 non-pregnant females of childbearing age (18-45 years) included in the multicenter observational Anticoagulation in the Treatment of Cerebral Venous Thrombosis study (ACTION-CVT). Comparisons were made between postpartum (first 12 weeks from delivery, n=38 [10.2%]) versus non-postpartum women (n=335 [89.8%]). The primary outcomes of interest were one-year risk of all-cause death, venous thromboembolism (VTE) recurrence, and major hemorrhage (i.e., new or worsening intracranial hemorrhage or major extracranial hemorrhage). Secondary outcomes were the discharge disposition and modified Rankin Scale (mRS) score at discharge and 90 days.


      Postpartum status was associated with greater risk of seizures (42.1% versus 20.9%, p=0.003), venous infarction (47.4% versus 29.5%, p=0.025), intracranial hemorrhage (55.3% versus 36.1%, p=0.022), and requirement for neurosurgical treatment (13.2% versus 3.6%, p=0.021). There was no significant association with one year all cause death (N=373 HR=1.35, 95%-CI=0.15-11.87, p=0.784), VTE recurrence (N=373, HR=1.27, 95%-CI=0.45-3.59, p=0.648), major hemorrhage (N=373, HR=1.36, 95%-CI=0.46-4.0, p=0.581) as well as excellent (mRS[0-1]: OR=1.58, 95%-CI=0.4-7.1, p=0.554) and good (mRS[0-2]: OR=0.92, 95%-CI=0.2-4.27, p=0.918) 90-day mRS. Results were similar after adjustment for potential confounders.


      Although CVST in the 12-week postpartum period was more frequently associated with early complications, 90-day functional disability and one-year outcomes were similar to women with CVST unrelated to pregnancy.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Stroke and Cerebrovascular Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ferro JM
        • Canhao P
        • Stam J
        • Bousser MG
        • Barinagarrementeria F
        • Investigators I.
        Prognosis of cerebral vein and dural sinus thrombosis: Results of the international study on cerebral vein and dural sinus thrombosis (iscvt).
        Stroke. 2004; 35: 664-670
        • Liang ZW
        • Gao WL
        • Feng LM.
        Clinical characteristics and prognosis of cerebral venous thrombosis in Chinese women during pregnancy and puerperium.
        Sci Rep. 2017; 7: 43866
        • Jeng JS
        • Tang SC
        • Yip PK.
        Incidence and etiologies of stroke during pregnancy and puerperium as evidenced in Taiwanese women.
        Cerebrovasc Dis. 2004; 18: 290-295
        • Coutinho JM
        • Ferro JM
        • Canhao P
        • Barinagarrementeria F
        • Cantu C
        • Bousser MG
        • et al.
        Cerebral venous and sinus thrombosis in women.
        Stroke. 2009; 40: 2356-2361
        • Roeder HJ
        • Lopez JR
        • Miller EC.
        Ischemic stroke and cerebral venous sinus thrombosis in pregnancy.
        Handb Clin Neurol. 2020; 172: 3-31
        • Silvis SM
        • Lindgren E
        • Hiltunen S
        • Devasagayam S
        • Scheres LJ
        • Jood K
        • et al.
        Postpartum period is a risk factor for cerebral venous thrombosis.
        Stroke. 2019; 50: 501-503
        • Cantu C
        • Barinagarrementeria F.
        Cerebral venous thrombosis associated with pregnancy and puerperium. Review of 67 cases.
        Stroke. 1993; 24: 1880-1884
        • Lanska DJ
        • Kryscio RJ.
        Risk factors for peripartum and postpartum stroke and intracranial venous thrombosis.
        Stroke. 2000; 31: 1274-1282
        • de Bruijn SF
        • Stam J
        • Koopman MM
        • Vandenbroucke JP.
        Case-control study of risk of cerebral sinus thrombosis in oral contraceptive users and in [correction of who are] carriers of hereditary prothrombotic conditions. The cerebral venous sinus thrombosis study group.
        BMJ. 1998; 316: 589-592
        • Dentali F
        • Crowther M
        • Ageno W.
        Thrombophilic abnormalities, oral contraceptives, and risk of cerebral vein thrombosis: a meta-analysis.
        Blood. 2006; 107: 2766-2773
        • Srinivasan K.
        Cerebral venous and arterial thrombosis in pregnancy and puerperium. A study of 135 patients.
        Angiology. 1983; 34: 731-746
        • Meng SH
        • Li JH
        • Zuo LJ
        • Feng LM.
        The outcomes of pregnant and postpartum patients with cerebral venous sinus thrombosis after anticoagulant therapy.
        Medicine (Baltimore). 2021; 100: e26360
        • Borhani Haghighi A
        • Edgell RC
        • Cruz-Flores S
        • Feen E
        • Piriyawat P
        • Vora N
        • et al.
        Mortality of cerebral venous-sinus thrombosis in a large national sample.
        Stroke. 2012; 43: 262-264
        • Uluduz D
        • Sahin S
        • Duman T
        • Ozturk S
        • Yayla V
        • Afsar N
        • et al.
        Cerebral venous sinus thrombosis in women: subgroup analysis of the venost study.
        Stroke Res Treat. 2020; 20208610903
        • Yaghi S
        • Shu L
        • Bakradze E
        • Salehi Omran S
        • Giles JA
        • Amar JY
        • et al.
        Direct oral anticoagulants versus warfarin in the treatment of cerebral venous thrombosis (action-cvt): a multicenter international study.
        Stroke. 2022; 53: 728-738
        • Kamel H
        • Navi BB
        • Sriram N
        • Hovsepian DA
        • Devereux RB
        • Elkind MS.
        Risk of a thrombotic event after the 6-week postpartum period.
        N Engl J Med. 2014; 370: 1307-1315
        • Razmara A
        • Bakhadirov K
        • Batra A
        • Feske SK.
        Cerebrovascular complications of pregnancy and the postpartum period.
        Curr Cardiol Rep. 2014; 16: 532
        • Klein AM
        • Loder E
        Postpartum headache.
        Int J Obstet Anesth. 2010; 19: 422-430
        • Kashkoush AI
        • Ma H
        • Agarwal N
        • Panczykowski D
        • Tonetti D
        • Weiner GM
        • et al.
        Cerebral venous sinus thrombosis in pregnancy and puerperium: a pooled, systematic review.
        J Clin Neurosci. 2017; 39: 9-15
        • Kate MP
        • Thomas B
        • Sylaja PN.
        Cerebral venous thrombosis in post-lumbar puncture intracranial hypotension: case report and review of literature.
        F1000Res. 2014; 3: 41
        • Patel SI
        • Pennell PB.
        Management of epilepsy during pregnancy: an update.
        Ther Adv Neurol Disord. 2016; 9: 118-129
        • Thorat N
        • Onkarappa SA
        • Karkal RN.
        Depression and quality of life after cerebral venous sinus thrombosis.
        J Neurol Sci. 2019; 405: 70-71