Is heparin better than LMWH in the initial treatment of cerebral venous sinus thrombosis?

Shout out to Team 7 for this great clinical question!

A recent unblinded randomised controlled trial of 83 patients in India showed (note both groups were bridged to acenacoumarol, a vitamin K antagonist)
- significant reduction in in-hospital mortality with LMWH compared to IV heparin
- non-significant improvement in functional status at 3 months with LMWH compared to IV heparin

Here is the link

Keep in mind that this is a very small study.

However these findings were consistent with what had been previously suggested in a prospective cohort study.

The bottom line? There is no data to suggest that IV heparin is better than LMWH in cerebral venous sinus thrombosis. In fact, there is some data suggestive of just the opposite.