{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:55:12Z","timestamp":1777859712984,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T00:00:00Z","timestamp":1600041600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:p>Cerebral venous sinus thrombosis (CVST) is an uncommon condition accounting for 0.5-1% of all strokes. It occurs more commonly in women, particularly in the age group of 20-40 years of age due to pregnancy and oral contraceptive use. Systemic anticoagulation is recommended as first line treatment but 10-20% of patients deteriorate despite medical treatment and require surgical or endovascular interventions. We summarize a 41-year-old female with a past medical history of acute disseminated encephalomyelitis who presented with headaches and worsening mental status. Further workup confirmed inferior sagittal sinus thrombus with intraventricular hemorrhage for which she was initiated on heparin continuous infusion. Due to worsening of clot burden and cerebral edema, a right frontal external ventricular drain was placed in addition to medical management of elevated ICP. Intravenous heparin infusion was stopped intermittently for such procedures. However, even when heparin was continued, sub-therapeutic and supra-therapeutic ranges were commonly observed, making anticoagulation management challenging. A new left-sided EVD had to be placed after increased IVH and worsening of hydrocephalus due to clotting. Due to patient\u2019s clinical worsening, a microcatheter was placed in the straight sinus and continuous alteplase via intra-sinus catheter was initiated at a rate of 1 mg\/hour. This was continued for 72 hours in addition to the continuous heparin infusion. Additionally, she received intraventricular alteplase 1 mg x 3 doses for IVH. Unfortunately, she continued to deteriorate despite maximal medical therapy. She was made comfort care and expired.<\/jats:p>","DOI":"10.1177\/0897190020958260","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T05:41:30Z","timestamp":1600062090000},"page":"140-147","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Prolonged Intra-Sinus Alteplase Infusion in Severe Case of CVST"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5945-8935","authenticated-orcid":false,"given":"Danine P.","family":"Sullinger","sequence":"first","affiliation":[{"name":"Critical Care and Surgery Pharmacy, Johns Hopkins Hospital, Baltimore MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5132-0958","authenticated-orcid":false,"given":"Sung-Min","family":"Cho","sequence":"additional","affiliation":[{"name":"Division of Neuroscience Critical Care, Departments of Neurology, Neurosurgery, and Anesthesia and Critical Care Medicine, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salia","family":"Farrokh","sequence":"additional","affiliation":[{"name":"Critical Care and Surgery Pharmacy, Johns Hopkins Hospital, Baltimore MD, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,9,14]]},"reference":[{"key":"bibr1-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1136\/pmj.76.891.12"},{"issue":"2","key":"bibr2-0897190020958260","first-page":"49","volume":"9","author":"Karanam LS","year":"2016","journal-title":"J Vasc Interv Neurol"},{"issue":"2","key":"bibr3-0897190020958260","first-page":"335","volume":"20","author":"Bushnell C","year":"2014","journal-title":"Continuum"},{"key":"bibr4-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1111\/jth.14210"},{"key":"bibr5-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1007\/s12028-018-0502-3"},{"key":"bibr6-0897190020958260","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2015.2198"},{"key":"bibr7-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1177\/1941874415591500"},{"key":"bibr8-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2006.01398.x"},{"key":"bibr9-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-018-2066-1"},{"key":"bibr10-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1161\/str.50.suppl_1.WP423"},{"key":"bibr11-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12462"},{"issue":"3","key":"bibr12-0897190020958260","first-page":"17","volume":"5","author":"Anticoli S","year":"2016","journal-title":"J Biomed Sci"},{"issue":"10","key":"bibr13-0897190020958260","first-page":"604","volume":"128","author":"Mimier M","year":"2018","journal-title":"Pol Arch Intern Med"},{"key":"bibr14-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2018.10.015"},{"key":"bibr15-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0b013e31820a8364"},{"issue":"6","key":"bibr16-0897190020958260","first-page":"e654","volume":"8","author":"Zie E","year":"2016","journal-title":"Cureus"},{"key":"bibr17-0897190020958260","doi-asserted-by":"publisher","DOI":"10.4103\/0972-2327.186785"},{"key":"bibr18-0897190020958260","doi-asserted-by":"publisher","DOI":"10.1007\/s00234-018-2084-3"},{"key":"bibr19-0897190020958260","doi-asserted-by":"publisher","DOI":"10.15274\/INR-2014-10032"},{"key":"bibr20-0897190020958260","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A2932"},{"key":"bibr21-0897190020958260","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1988.68.2.0284"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190020958260","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0897190020958260","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190020958260","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:36:14Z","timestamp":1777509374000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0897190020958260"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,9,14]]},"references-count":21,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,2]]}},"alternative-id":["10.1177\/0897190020958260"],"URL":"https:\/\/doi.org\/10.1177\/0897190020958260","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9,14]]}}}