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(Stroke. 1999;30:1729.)
© 1999 American Heart Association, Inc.

Letters to the Editor

Cerebral Venous Thrombosis: Nothing, Heparin, or Local Thrombolysis?

M. B. Lewis

Specialist Registrar in Neurology, St James's University Hospital, Leeds, UK

	Introduction

 
To the Editor:

I really must object to the recent editorial in your journal reviewing trials in cerebral venous thrombosis (CVT).¹

As someone who tries to practice evidence-based medicine whenever possible, I cannot understand how Dr Bousser can suggest that although treatment with heparin offers no statistical benefit over treatment with placebo, it should be used as the treatment of choice for all CVT. She even suggests that further placebo-controlled trials would be unethical. This is a complete nonsense! Further properly conducted, placebo-controlled trials are just what are needed to answer the questions associated with the management of CVT.

I suspect some of the difficulty with this issue comes from the fact that, as physicians, we find it very difficult to do nothing. If, for example, the trial had been comparing an established treatment with a new treatment and had produced the figures this trial produced,² we would not even be having a debate as to whether the new treatment should be adopted. No benefit would have been shown, and unless it was superior in other ways, such as side effect profile or pricing, it would be abandoned.

With this in mind, it is difficult to conceive of a cheaper or more side-effect-free treatment than nothing.

	References

 
1. Bousser M-G. Cerebral venous thrombosis: nothing, heparin or local thrombolysis. Stroke.. 1999;30:481–483.[Free Full Text]

2. de Bruijn SFTM, Stam J, for the Cerebral Venous Sinus Thrombosis Group. Randomized, placebo-controlled trial of anticoagulant treatment with low-molecular-weight heparin for cerebral sinus thrombosis. Stroke.. 1999;30:484–488.[Abstract/Free Full Text]

Response

Marie-Germaine Bousser, MD

Neurology Department, Hopital Lariboisière, Paris, France

Key Words: cerebral venous thrombosis • heparin • thrombolysis

	Introduction

 
I am afraid I don't really understand what point Dr Lewis wants to make about my editorial on CVT.¹ Does he really mean that "nothing" is the treatment of choice for CVT? How many CVT patients has he treated with "nothing," and what was . . . [Full Text of this Article]

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				M B LEWIS Cerebral venous sinus thrombosis: heparin or nothing? Postgrad. Med. J., July 1, 2000; 76(897): 453c - 453. [Full Text]