Serebral Ven Trombozunda Güncel Tedavi
Özet
Serebral venöz tromboz (SVT), esas olarak genç yetişkinleri etkileyen ve tüm inmelerin %0,5-1’ini temsil eden nadir bir inme nedenidir ve çoğunlukla genç kadınları etkiler. SVT etiyolojisinde herediter ve sekonder birçok faktör sorumludur. Koagülopatiler, kan diskrazileri, inflamatuar hastalıklar, kollagen doku hastalıkları, gebelik, lohusalık, hormon replasman tedavileri, sistemik enfeksiyonlar, menenjit, santral venöz kateter, lomber ponksiyon gibi tanısal ve tedavi amaçlı girişimler nedenler arasındadır. SVT tedavisinde temel yaklaşım, intravenöz fraksiyone olmayan Heparin (UFH) veya subkutan düşük moleküler ağırlıklı heparin (DMAH) ile antikoagülan tedaviye başlamaktır. Klinik stabilizasyonun ardından parenteral antikoagülasyondan oral antikoagülasyona geçilir. Oral antikoagülasyon için direkt oral antikoagülanlar (DOAK), vitamin K antagonistlerine (VKA) tercih edilmelidir. Tekrarlayan SVT veya ekstraserebral venöz tromboz riski düşük olan SVT hastalarında, antikoagülasyon 3 ila 12 ay sonra kesilmelidir. Sonuç olarak, SVT de altta yatan nedenlerin ve risk faktörlerinin belirlenmesi prognoz ve uzun dönem tedavi belirlenmesi açısından önemlidir.
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