Bloody Minded Episode 73 - What A Headache | CVST and Antithrombin Deficiency with Dr Caroline Dix
Dec 16, 2025
Dr. Caroline Dix, a Consultant haematologist at the Austin Hospital, delves into the complexities of thrombotic disorders. She explains the nuances of Cerebral Venous Sinus Thrombosis (CVST), highlighting risk factors for young women and the critical role of anticoagulation even in the presence of hemorrhage. Caroline also breaks down antithrombin deficiency, exploring types, diagnostic tests, and management strategies, including tailored anticoagulant choices and the importance of monitoring during pregnancy. Her insights make thrombosis fascinating!
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Bleeding In CVST Is Often Clot-Driven
- Intracranial hemorrhage in CVST is often caused by venous hypertension from the clot, not primary vessel rupture.
- Anticoagulation is commonly indicated despite intracranial bleeding because treating the clot relieves venous pressure.
Prefer DOACs For Most CVST Cases
- Use DOACs for most CVST patients; trials (RESPECT-CVT) and large observational data show similar outcomes to warfarin.
- Reserve warfarin, LMWH in pregnancy, or alternatives when antiphospholipid syndrome, drug interactions, or specific scenarios exist.
Low Recurrence But High Survivorship Anxiety
- CVST recurrence rates are relatively low compared with other VTE, influencing duration decisions.
- Many patients choose extended anticoagulation for peace of mind given the life-changing nature of CVST.