{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:48:47Z","timestamp":1791902927367,"version":"4.3.4"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1999,3]]},"abstract":"<jats:p>\n            <jats:italic>Background and Purpose<\/jats:italic>\n            \u2014We chose to evaluate the safety and efficacy of combined intrathrombus rtPA and intravenous heparin in cerebral venous thrombosis (CVT).\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods<\/jats:italic>\n            \u2014We treated 12 patients with symptoms of 1 to 40 days\u2019 duration (eg, headache, somnolence, focal deficits, seizures, and nausea and vomiting). Pretreatment MRI disclosed subtle hemorrhagic venous infarction in 4 patients, obvious hemorrhagic infarction in 2, small parenchymal hemorrhage from recent pallidotomy in 1, and no focal lesion in 5. Magnetic resonance venography and contrast venography identified thrombi in the superior sagittal sinus (SSS) in 3 patients; transverse\/sigmoid sinus (TS\/SS) in 2; SSS and both TS\/SS in 1; SSS and 1 TS\/SS in 5; and SSS, 1 TS\/SS, and straight sinus in 1 patient. A loading dose of rtPA was instilled throughout the clot at 1 mg\/cm, followed by continuous intrathrombus infusion at 1 to 2 mg\/h. Intravenous heparin was infused concomitantly.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Results<\/jats:italic>\n            \u2014Flow was restored completely in 6 patients and partially in 3, with a mean rtPA dose of 46 mg (range, 23 to 128 mg) at a mean time of 29 hours (range, 13 to 77 hours). Symptoms improved in these 9 patients concomitantly with flow restoration. Flow could not be restored in 3 patients. In 1 of them, treatment was stopped when little progress had been made, and fibrinogen level dropped to 118 mg\/dL. In the other 2 patients, hemorrhagic worsening occurred, and treatment was abbreviated after initial rtPA dosing. In 1 of these, the hematoma was evacuated.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014Our experience with intrathrombus rtPA in conjunction with intravenous heparin in patients with CVT is encouraging. This therapy should probably be regarded as unsafe in patients with obvious hemorrhage. Time to restore flow may be faster than with urokinase (an average of 71 hours has been reported for 29 documented patients). Further evaluation of rtPA with heparin in CVT is warranted.\n          <\/jats:p>","DOI":"10.1161\/01.str.30.3.489","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"489-494","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":152,"title":["Cerebral Venous Thrombosis"],"prefix":"10.1161","volume":"30","author":[{"given":"James L.","family":"Frey","sequence":"first","affiliation":[{"name":"From the Barrow Neurological Institute, Phoenix, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard J.","family":"Muro","sequence":"additional","affiliation":[{"name":"From the Barrow Neurological Institute, Phoenix, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron G.","family":"McDougall","sequence":"additional","affiliation":[{"name":"From the Barrow Neurological Institute, Phoenix, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce L.","family":"Dean","sequence":"additional","affiliation":[{"name":"From the Barrow Neurological Institute, Phoenix, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heidi K.","family":"Jahnke","sequence":"additional","affiliation":[{"name":"From the Barrow Neurological Institute, Phoenix, Ariz."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_1_2","doi-asserted-by":"publisher","DOI":"10.1161\/str.16.2.3975957"},{"key":"e_1_3_1_2_2","unstructured":"Bousser MG Barnett HJM. Cerebral venous thrombosis. In: Barnett HJM Mohr JP Stein BM Yatsu FM eds. Stroke: Pathophysiology Diagnosis and Management. 2nd ed. New York NY: Churchill Livingstone; 1992:517\u2013537."},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1977.00500130022004"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0733-8619(18)30235-4"},{"key":"e_1_3_1_5_2","first-page":"72","volume":"21","year":"1994","unstructured":"Villringer A, Mehraein S, Einh\u00e4upl KM. Pathophysiological aspects of cerebral sinus venous thrombosis (SVT). 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Paper presented at: 23rd International Joint Conference on Stroke and Cerebral Circulation; February 5 1998; Orlando Fla."}],"container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.STR.30.3.489","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T22:02:29Z","timestamp":1715551349000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.STR.30.3.489"}},"subtitle":["Combined Intrathrombus rtPA and Intravenous Heparin"],"short-title":[],"issued":{"date-parts":[[1999,3]]},"references-count":36,"journal-issue":{"issue":"3","published-print":{"date-parts":[[1999,3]]}},"alternative-id":["10.1161\/01.STR.30.3.489"],"URL":"https:\/\/doi.org\/10.1161\/01.str.30.3.489","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[1999,3]]},"assertion":[{"value":"1998-07-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1998-10-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1999-03-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}