NEW Cerebral Venous Thrombosis

The CSBPR Cerebral Venous Thrombosis module provides guidance to healthcare providers caring for adult individuals who present to the healthcare system with current or recent symptoms of cerebral venous thrombosis. This module addresses management and care of individuals with CVT across the continuum of care starting with first presentation to the healthcare system.

The detailed methodology and explanations for each of these steps in the development and dissemination of the CSBPR is available in the Canadian Stroke Best Practices Recommendations Overview and Methodology manual available on the Canadian Stroke Best Practices website.

Conflicts of Interest: All potential participants in the recommendation development and review process are required to complete confidentiality agreements and declare all actual and potential conflicts of interest prior to participation. Declared conflicts of interest are reviewed by the co-chairs of the CSBPR Advisory Committee and Heart & Stroke staff to assess the potential impact. Those with significant conflicts with respect to the module topic are not selected for writing group or reviewer roles.

Participants who have conflicts for a particular topic area are identified at the beginning of discussions for that topic and are recused from voting. If a co-chair is in conflict, they are recused from their responsibilities for that discussion and another non-conflicted participant assumes the role for that discussion and vote. Heart & Stroke senior staff members participate in all writing group discussions and intervene if they perceive an untoward bias by a writing group member.

Conflict of interest declarations for the Cerebral Venous Thrombosis module writing group members can be found in Appendix One.

Heart & Stroke gratefully acknowledges the Cerebral Venous Thrombosis writing group leaders and members, all of whom have volunteered their time and expertise to develop these new recommendations. Members of the Canadian Stroke Consortium were involved in all aspects of the development of these recommendations. These recommendations (in whole or specific parts) underwent external review by Diana Aguiar de Sousa, Lana Castellucci, Luciana Catanese, Johnathon Coutinho, Laura Gioia, Brett Graham, Sherry Hu, Sylvain Lanthier, Neshika Samarasekera, Arturo Tamayo, and Katie White.

We thank the Canadian Stroke Best Practices and Quality Advisory Committee members: Eric E. Smith (Co-Chair), Anita Mountain (Co-Chair), Gord Gubitz, Dar Dowlatshahi, Dylan Blacquiere, Margie Burns, Thalia S. Field, Farrell Leibovitch, Christine Papoushek, Jeffrey Habert, Joyce Fung, Michael D Hill, Eddy Lang, Pascale Lavoie, Beth Linkewich, Colleen O’Connell, Jai Shankar, Debbie Timpson, Theodore Wein, and Katie White. The performance measures were reviewed and updated by the Heart & Stroke health systems quality council including Amy Yu (Chair), Michael D Hill, Aravind Ganesh, Sacha Arsenault, Christine Hawkes, Raed Joundi, Laura Gioia, Noreen Kamal, Shannon MacDonald, Katharine Mckeen, Kathryn Yearwood, Leigh Botly, and Laura Holder.

We acknowledge and thank Norine Foley and the evidence analysis team at workHORSE; Laurie Charest of Heart & Stroke for her coordination of the CSBPR teams and processes; and Francine Forget Marin and the Heart & Stroke internal teams who contributed to the development and publication of these recommendations (Translation, Communications, Knowledge Translation, Engagement, Health Policy, and Digital Solutions).

Heart & Stroke is especially grateful to the members of the Cerebral Venous Thrombosis Community Consultation and Review Panel who worked in tandem with the scientific writing group for this module and shared their personal experiences and insights on living with cerebral venous thrombosis and optimizing recovery and health outcomes. CCRP members include Annette Greenwood, Estee Polnau, and Aviva Rappaport.

Thalia S. Field (Co-Chair), Jennifer Mandzia (Co-Chair), M. Patrice Lindsay (Corresponding Author), Theodore Wein (Senior Advisor), Rebecca Lund, Chelsy Martin, Deborah Siegal, Derek B. Debicki, Johnathon Gorman, Leonard A. Levin, Mahendranath Moharir, Lissa Peeling, Kanjana S. Perera, Steve Verreault, Norine Foley, Anita Mountain and Eric E. Smith; on Behalf of the Canadian Stroke Best Practice Recommendations Advisory Committee, in collaboration with the Canadian Stroke Consortium. Canadian Stroke Best Practice Recommendations: Cerebral Venous Thrombosis, 7th Edition, 2024; Toronto, Ontario, Canada: Heart and Stroke Foundation. In M. Patrice Lindsay, Anita Mountain, Rebecca Lund, Chelsy Martin, Theodore Wein, and Eric E. Smith (Editors), on behalf of the Canadian Stroke Best Practices and Advisory Committee in collaboration with the Canadian Stroke Consortium. Canadian Stroke Best Practice Recommendations, 7th edition, 2024; Toronto, Ontario, Canada: Heart and Stroke Foundation of Canada.

• Cerebral Venous Thrombosis guideline publication 
• Writing Group Members and External Reviewers (Appendices One & Two)
• Cerebral Venous Thrombosis Definitions and Descriptions

1.0 Diagnosis and Initial Clinical Assessment of Symptomatic Cerebral Venous Thrombosis

• Table 1: Common Clinical Features at the Time of Presentation with CVT
• Figure 1: Patient Characteristics, Risk Factors, and Conditions Associated with Cerebral Venous Thrombosis
• Cerebral Venous Thrombosis Evidence Table and Reference List

2.0   Acute Treatment of Symptomatic Cerebral Venous Thrombosis

• Cerebral Venous Thrombosis Evidence Table and Reference List

3.0 Post-Acute Management of Cerebral Venous Thrombosis and Person-Centered Care

• Cerebral Venous Thrombosis Evidence Table and Reference List 

4.0 Special Considerations in the Longterm Management of Individuals with Cerebral Venous Thrombosis

• Cerebral Venous Thrombosis Evidence Table and Reference List 

5.0 Considerations Related to Cerebral Venous Thrombosis in Special Circumstances

• Cerebral Venous Thrombosis Evidence Table and Reference List 

Appendix One: Cerebral Venous Thrombosis Scientific Writing Group and Authors 2024

Appendix Two: Cerebral Venous Thrombosis External Reviewers 2024

Appendix Three: Recommended Laboratory Investigations for Individuals with Cerebral Venous Thrombosis

Appendix Four: Antiphospholipid Antibody Syndrome (APS) Testing Flowsheet 

Appendix Five: References for Evidence Summaries