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(Stroke. 2001;32:2310.)
© 2001 American Heart Association, Inc.

Original Contributions

Nonrandomized Comparison of Local Urokinase Thrombolysis Versus Systemic Heparin Anticoagulation for Superior Sagittal Sinus Thrombosis

M. Wasay, MD; R. Bakshi, MD; S. Kojan, MD; G. Bobustuc, MD; N. Dubey, MD D.H. Unwin, MD

From the Department of Neurology, Aga Khan University, Karachi, Pakistan (M.W.); Department of Neurology, University at Buffalo–State University of New York, and Imaging Services, Kaleida Health, Buffalo, NY (R.B.); Department of Neurology and Mobility Foundation Center, University of Texas Southwestern Medical Center, Dallas (S.K., D.H.U.); and Department of Neurology, University of Texas Health Science Center, Houston (G.B., N.D.).

Correspondence to Rohit Bakshi, MD, Buffalo Neuroimaging Analysis Center, 100 High St, Suite E-2, Buffalo, NY 14203. E-mail rbakshi{at}buffalo.edu

Background and Purpose—— We sought to compare the safety and efficacy of direct urokinase thrombolysis with systemic heparin anticoagulation for superior sagittal sinus thrombosis (SSST).

Methods—— At University at Buffalo (NY) and University of Texas (Dallas, Houston), we reviewed 40 consecutive patients with SSST, treated with local urokinase (thrombolysis group) or systemic heparin anticoagulation (heparin group). The thrombolysis group (n=20) received local urokinase into the SSS followed by systemic heparin anticoagulation. The heparin group (n=20) received systemic heparin anticoagulation only. Neurological dysfunction was rated 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), and predisposing illnesses (P=0.52) were similar between the thrombolysis and heparin groups. Pretreatment neurological function was worse in the thrombolysis group (normal, n=5; mild, n=8; moderate, n=4; severe, n=3) than in the 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 (normal, n=16; mild, n=3; moderate, n=1; severe, n=0) than in the heparin group (normal, n=9; mild, n=6; moderate, n=5; severe, n=0) (P=0.019, Mann-Whitney U test). Hemorrhagic complications were 10% (n=2) in the thrombolysis group (subdural hematoma, retroperitoneal hemorrhage) and none in the heparin group (P=0.49). Three of the heparin group patients developed complications of the underlying disease (status epilepticus, hydrocephalus, refractory papilledema). No deaths occurred. Length of hospital stay was similar between 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 treating SSST. A randomized, prospective study comparing these 2 treatments for SSST is warranted.

Editorial Comment

Peter Gates, MBBS, FRACP, Guest Editor * Richard Gerraty, MD, FRACP, Guest Editor

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