Identifying High-Risk Patients With Cerebral Venous Thrombosis for Early Intervention

BACKGROUND: Cerebral venous thrombosis presents with diverse clinical features, making early recognition of patients at risk for deterioration challenging. The cerebral venous thrombosis score was developed by our group and later renamed the CLOTS-EVT score as a mnemonic to facilitate recall and improve ease of clinical use. This 10-point tool, including decreased consciousness (C), low platelets and sodium (L), absence of oral contraceptive use (O), thrombosis burden >3 sinuses (T), seizure (S), and papilledema (E), was developed to predict early deterioration and guide timely venous thrombectomy. We aimed to externally validate this score. METHODS: We retrospectively analyzed adults with cerebral venous thrombosis treated between 2015 and 2017 across 12 centers. Clinical, laboratory, and imaging data were collected, and the CLOTS-EVT score was applied to each patient. Predictive performance was evaluated using sensitivity, specificity, predictive values, and the area under the receiver operating characteristic curve. Correlation with functional outcome at discharge and hospital length of stay was assessed. RESULTS: Eighty patients were analyzed (median age, 38.5 years; 66% female). Headache was the most common symptom; oral contraceptive use was reported in one-third of women. Additional risk factors included pregnancy (7.5%), central nervous system infection (1.25%), malignancy (6.25%), hereditary thrombophilia (3.75%), and smoking (15%). The transverse and sigmoid sinuses were most frequently involved. Anticoagulation was initiated in nearly all patients; 10% underwent endovascular therapy. Overall, 63.8% achieved favorable outcomes, 80% were discharged home, and mortality was 3.8%. In this cohort, 41.3% had decreased consciousness, 47.5% had sodium <139 mEq/L, 38.8% had platelets <225 000/μL, 68.75% were not using oral contraceptives, 25% had thrombosis in >3 sinuses, 20% had seizures, and 22.5% had papilledema. A CLOTS-EVT score ≥4 predicted early deterioration with 82% sensitivity, 61% specificity, and an area under the receiver operating characteristic curve of 0.718. Higher scores correlated with longer hospital stay (r=0.325) and worse functional outcome (r=0.363). CONCLUSIONS: The CLOTS-EVT score demonstrated acceptable performance as a predictor of early deterioration in cerebral venous thrombosis. By combining standard clinical, laboratory, and imaging variables, it provides a practical tool for risk stratification and may inform consideration of venous thrombectomy alongside anticoagulation.