Low molecular weight heparin versus unfractionated heparin in the management of cerebral venous thrombosis: A systematic review and meta-analysis

INTRODUCTION: There are two main choices of anti-coagulation in cerebral venous thrombosis: Unfractionated heparin versus low molecular weight heparin. A consensus is yet to be reached regarding which agent is optimal. Therefore the aim of this systematic review and meta-analysis was to identify which agent is most effective in treating CVT. METHODS: Databases Pubmed (MEDLINE), Google Scholar and hand-picked references from papers of interest were reviewed. Studies comparing the use of low molecular weight heparin and unfractionated heparin in adult patients with a confirmed diagnosis of cerebral vein thrombosis were selected. Data was recorded for patient mortality, functional outcome and haemorrhagic complications of therapy. RESULTS: A total of 2761 papers were identified, 74 abstracts were screened, with 5 papers being read in full text and three studies suitable for final inclusion. A total of 179 patients were in the LMWH group and 352 patients were in the UH group. Mortality and functional outcome trended towards favouring LMWH with OR [95% CI] of 0.51 [0.23, 1.10], p = 0.09 and 0.79 [0.49, 1.26] p = 0.32 respectively. There was no difference in extra-cranial haemorrhage rates between either agent with a OR [95% CI] of 1.00 [0.29, 3.52] p = 0.99. CONCLUSION: Trends towards improved mortality and improved functional outcomes were seen in patients treated with LMWH. No result reached statistical significance due to low numbers of studies available for inclusion. There is a need for further large scale randomized trials to definitively investigate the potential benefits of LMWH in the treatment of CVT.