Cerebral venous thrombosis (CVT) occurring in a female patient during pregnancy or the puerperium is a clinically distinct situation that calls for a carefully defined management approach specific to this population.
This protocol addresses CVT in female patients who are pregnant or in the puerperium — the period following delivery. Both settings impose important constraints and considerations that directly shape the clinical strategy chosen.
In cases of neurological deterioration or thrombus progression, an endovascular approach — involving catheter-based intervention — may be part of the management plan.
DOI: 10.1161/STR.0000000000000456
Therefore, anticoagulation for CVT during pregnancy and early in the puerperium consists of LMWH in the majority of women.
DOACs are not suitable in women who are pregnant (both DOAC and warfarin are contraindicated; only LMWH is recommended) or breastfeeding (DOACs are contraindicated; Figure 4).
As in nonpregnant women, thrombolysis and thrombectomy are reserved for patients with neurological deterioration or propagation of the thrombus despite medical therapy (Figure 4).
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