Randomized controlled trial of heparin in puerperal cerebral venous/sinus thrombosis

Cerebral Venous/sinus Thrombosis (CVT) is an important cause of maternal mortality during the puerperium. Use of heparin has been debatable due to fear of hemorrhagic complications. Here, me report the results of the randomized control trial of heparin, Fifty-seven patients of puerperal CVT diagnosed clinically and radiologically were randomized into therapy group (29) and control group (28), After detailed clinical, radiological, hematological and biochemical investigations, therapy group received IV heparin 5000 units every 6 hourly to begin with and the dose was adjusted to keep the clotting time less than 7 minutes and partial thromboplastin time less than one and half times the normal, Both groups received anti convulsants and anti oedema measures, in addition to correction of anaemia, Heparin was tapered after 30th post partum day, Headache was reduced in the heparin group in 24-72 hours clearing in 7-10 days while in control group it was severe and continued for 2-3 weeks, Two patients died in the control group with one person having residual hemiparesis even after 6 months. There were no deaths in the therapy group and all mere independent at 6th month, Though, there was an initial deterioration of clinical state in 2 patients of each group, on repeat CT examination in ten patients, there mere no hemorrhagic complications in any.