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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of cerebral venous sinus thrombosis
  1. Yuhua Fan1,
  2. Jian Yu1,
  3. Hongbing Chen1,
  4. Jian Zhang1,
  5. Jiangang Duan2,
  6. Dapeng Mo3,
  7. Wenhao Zhu4,
  8. Bo Wang3,
  9. Fubing Ouyang1,
  10. Yicong Chen1,
  11. Linfang Lan1,
  12. Jinsheng Zeng1
  13. Chinese Stroke Association Stroke Council CVST Guideline Writing Committee
    1. 1 Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory for Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, China
    2. 2 Department of Neurology and Department of Emergency, Xuanwu Hospital, Capital Medical University, Beijing, China
    3. 3 Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    4. 4 Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
    1. Correspondence to Professor Jinsheng Zeng; zengjs{at}pub.guangzhou.gd.cn

    Abstract

    Aim Cerebral venous sinus thrombosis (CVST) is a less common cerebrovascular disease that predominantly affects young patients. The incidence of CVST is 2–5/10 000 000/year, accounting for 0.5%–1% of all stroke. To reduce mortality and morbidity associated with CVST, Chinese Stroke Association commissioned the authors to write the current guideline on the management of CVST.

    Methods PubMed (MEDLINE), CNKI and Wanfang database were searched for studies related to CVST from 1 January 1990 to 31 July 2019. Data were synthesised by evidence tables. Each recommendation was fully discussed by the writing group members and reviewed by Chinese Stroke Association Stroke Fellow Committees. Levels of evidence grading algorithm of Chinese Stroke Association was used to grade each recommendation.

    Results This guideline mainly focuses on the diagnostic evaluation, therapeutic strategies and secondary prevention of CVST. CT/CTV and MRI/MRV are recommended in the initial imaging evaluation of patients with suspected CVST. Anticoagulation therapy with low-molecular weight heparin should be initiated in patients with CVST immediately. After the acute stage, warfarin is recommended for 3–6 months to prevent the recurrence of CVST and other venous thromboembolic events.

    Conclusions The guideline summarises the current evidence regarding the management of CVST, and provides references for diagnosis, treatment and secondary prevention of CVST in China.

    • vein
    • brain
    • MRI
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    Footnotes

    • Correction notice This paper has been updated since first published to remove duplicate headings for figures 1 and 2, and to update the list of collaborators.

    • Collaborators Chinese Stroke Association Stroke Council Guideline Writing Committee. Chairmen: Yongjun Wang, yongjunwang{at}ncrcnd.org.cn, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Jizong Zhao, zhaojz205@163.com / zhaojz{at}public.bta.net.cn, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. Vice-Chairmen: , dong_qiang{at}fudan.edu.cn, Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; Anding Xu, tlil{at}jnu.edu.cn, Department of Neurology and Stroke Center, the First Affiliated Hospital, Jinan University, Guangzhou, China. Members of Academic Committee: Kangning Chen, ckn_640827{at}126.com’ Department of Neurology, The Southwest Hospital, the First Affiliated Hospital of Third Military Medical University, Chongqing, China; Junbo Ge, ge.junbo{at}zs-hospital.sh.cn’ Shanghai Institute of Cardiovascular Diseases, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Li Guo, guoli6{at}163.com, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China; Li He, heli2003new{at}126.com, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Bo Hu, hubo{at}hust.edu.cn, Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China; Yong Huo, huoyong{at}263.net.cn’ Department of Cardiology, Peking University First Hospital, Beijing, China; Linong Ji, jiln{at}bjmu.edu.cn, Department of Endocrinology and Metabolism, Peking University People's Hospital, Medicine at Peking University, Beijing, China; Xunming Ji, robertjixm{at}hotmail.com / jixunming{at}vip.163.com, Department of Neurosurgery, Xuanwu Hospital, Capital University of Medicine, Beijing, China; Tielin Li, tielin2013{at}126.com / tielin.li{at}tom.com, Zhujiang Hospital of Southern Medical University, Guangzhou, China; Liping Liu, lipingsister{at}gmail.com, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Benyan Luo, luobenyan{at}zju.edu.cn, Department of Neurology, 1st Affiliated Hospital of Zhejiang University, Hangzhou, China; Zhongrong Miao, zhongrongm{at}163.com, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Xiaoyuan Niu, niuxiaoyuan1958{at}163.com, Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China; Bin Peng, pengbin3{at}hotmail.com; Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Dingfeng Su, dfsu{at}smmu.edu.cn, Department of Pharmacology, the Second Military Medical University (SMMU), Shanghai, China; Beisha Tang, bstang7398{at}163.com, Department of Neurology, Xiangya Hospital, Central South University, Changsha, China; Chen Wang, wangchen-tr2002{at}163.com, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Ning Wang, nwang900{at}yahoo.com, Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China; Shuo Wang, captain9858{at}vip.sina.com, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Wei Wang, wwang{at}vip.126.com / wwang{at}tjh.tjmu.edu.cn, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Xin Wang, wang.xin{at}zs-hospital.sh.cn, Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China; Yilong Wang, yilong528{at}aliyun.com, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Shizheng Wu, wushizheng2005{at}hotmail.com, Qinghai Province People's Hospital, Xining, China; Peng Xie, xiepeng{at}cqmu.edu.cn, Chongqing Medical University (CQMU), Chongqing, China; Yuming Xu, 13903711125{at}126.com / xym13903711125{at}126.com, Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China; Yun Xu, xuyun20042001{at}aliyun.com, Department of Neurology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China; Yi Yang, doctoryangyi{at}163.com / doctor_yangyi{at}hotmail.com, Department of Neurology, the First Hospital of Jilin University, Changchun, China; Jinsheng Zeng, zengjs{at}pub.guangzhou.gd.cn, Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, Guangdong, China; Chaodong Zhang, scdzhang{at}163.com, The First affiliated Hospital of China Medical University, Shenyang, China; Tong Zhang, zt61611{at}sohu.com, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing, China; Zhuo Zhang, zzhuo005{at}gmail.com, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Gang Zhao, zhaogang{at}fmmu.edu.cn, Department of Neurology, Xijing Hospital, The 4th Military Medical University, Xi’an, China; Xingquan Zhao, zxq{at}vip.163.com, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    • Contributors JZ* designed the protocol and framework and also participated in revision. YF drafted the sections of diagnosis strategy and general management and revised the whole manuscript. DM and BW drafted the section of epidemiology. HC and JZ# drafted the section of imaging examination in diagnosis. WZ drafted the section of laboratory examination in diagnosis. JY and LL drafted the section of medicine treatment. JD, YC and FO drafted the section of endovascular treatment and prevention. JZ reviewed all the studies’ design and interpretation, and confirmed the level of evidence and classification. note: JZ * refers to Jinsheng Zeng, JZ# refers to Jian Zhang

    • Funding This research received specific funding from Chinese Stroke Association Guidelines Writing Committee.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; externally peer reviewed.

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