Nonrandomized comparison of local urokinase thrombolysis versus systemic heparin anticoagulation for superior sagittal sinus thrombosis

Background and Purpose-We sought to compare the safety and efficacy of dire ct urokinase thrombolysis with systemic heparin anticoagulation for superio r sagittal sinus thrombosis (SSST). Methods-At University at Buffalo (NY) and University of Texas (Dallas, Hous ton), we reviewed 40 consecutive patients with SSST, treated with local uro kinase (thrombolysis group) or systemic heparin anticoagulation (heparin gr oup). The thrombolysis group (n=20) received local urokinase into the SSS f ollowed by systemic heparin anticoagulation. The heparin group (n=20) recei ved systemic heparin anticoagulation only. Neurological dysfunction was rat ed as follows: 0, normal; 1, mild (but able to ambulate and communicate); 2 , moderate (unable to ambulate, normal mentation); and 3, severe (unable to ambulate, altered mentation). Results-Age (P=0.49), sex (P=0.20), baseline venous infarction (P=0.73), an d predisposing illnesses (P=0.52) were similar between the thrombolysis and heparin groups. Pretreatment neurological function was worse in the thromb olysis group (normal, n=5; mild, n=8; moderate, n=4; severe, n=3) than in t he heparin group (normal, n=8; mild, n=8; moderate, n=3; severe, n=1) (P=NS ). Discharge neurological function was better in the thrombolysis group (no rmal, n=16; mild, n=3; moderate, n=1; severe, n=0) than in the heparin grou p (normal, n=9; mild, n=6; moderate, n=5; severe, n=0) (P=0.019, Mann-Whitn ey U test). Hemorrhagic complications were 10% (n=2) in the thrombolysis gr oup (subdural hematoma, retroperitoneal hemorrhage) and none in the heparin group (P=0.49). Three of the heparin group patients developed complication s of the underlying disease (status epilepticus, hydrocephalus, refractory papilledema). No deaths occurred. Length of hospital stay was similar betwe en the groups (P=0.79). Conclusions-Local thrombolysis with urokinase is fairly well tolerated and may be more effective than systemic heparin anticoagulation alone in treati ng SSST. A randomized, prospective study comparing these 2 treatments for S SST is warranted.