Bloody Minded Episode 73 - What A Headache | CVST and Antithrombin Deficiency with Dr Caroline Dix
Dec 16, 2025
Dr. Caroline Dix, a Consultant haematologist at the Austin Hospital, delves into the complexities of thrombotic disorders. She explains the nuances of Cerebral Venous Sinus Thrombosis (CVST), highlighting risk factors for young women and the critical role of anticoagulation even in the presence of hemorrhage. Caroline also breaks down antithrombin deficiency, exploring types, diagnostic tests, and management strategies, including tailored anticoagulant choices and the importance of monitoring during pregnancy. Her insights make thrombosis fascinating!
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CVST Affects Young Women Disproportionately
- CVST affects younger patients and disproportionately females compared with typical VTE demographics.
- Estrogen exposures (OCP, pregnancy) and synergistic factors like thrombophilia and obesity strongly predispose to CVST.
Consider CVST With Headache Or New Seizures
- Think CVST in young patients with new headache, nausea/vomiting or unexplained seizures, even without focal neurology.
- Obtain CT venogram or MR venogram when suspicion is present rather than dismissing isolated headache.
Bleeding In CVST Is Often Clot-Driven
- Intracranial hemorrhage in CVST is often caused by venous hypertension from the clot, not primary vessel rupture.
- Anticoagulation is commonly indicated despite intracranial bleeding because treating the clot relieves venous pressure.