Treatment with UFH was associated with worse clinical outcomes compared with enoxaparin in acute cerebral venous thrombosis, largely attributable to suboptimal and inconsistent anticoagulation; when UFH achieves consistent therapeutic levels, outcomes are comparable.
In 359 patients with acute cerebral venous thrombosis, 61.3% received UFH and 38.7% received enoxaparin.
Only 64% of partial thromboplastin time (PTT) values in UFH-treated patients fell within the therapeutic range.
UFH was associated with worse functional outcomes at discharge than enoxaparin.
UFH was associated with worse 6-month functional outcome (mRS 3-6) than enoxaparin.
Poor recovery among UFH patients was independently linked to the UFH composite responsiveness index and to frequent infusion-rate adjustments.
When analysis was limited to UFH patients with consistently therapeutic PTT values, the outcome differences between UFH and enoxaparin diminished.
Age was independently associated with UFH responsiveness.
Female sex, body mass index, and neutrophil-to-lymphocyte ratio (NLR) were independently associated with the number of UFH infusion-rate adjustments.
This study looked at 359 adults with a new blood clot in the veins of the brain (cerebral venous thrombosis) who were treated with one of two blood thinners: unfractionated heparin (UFH, given by continuous IV drip) or enoxaparin (a low-molecular-weight heparin given by injection). Patients on UFH had worse recovery, both at hospital discharge and at 6 months, than those given enoxaparin, even after accounting for other factors. The difference appeared to be tied to how well UFH was controlled rather than the drug itself. Only about 64% of blood-clotting test values in UFH patients were in the target range, and patients whose doses needed frequent adjustment or who responded poorly had worse recovery. When the analysis was limited to UFH patients whose tests were consistently in the target range, the gap in outcomes shrank. Age, sex, body mass index, and a blood inflammation marker (NLR) were linked to how hard UFH was to manage. This research suggests that enoxaparin's more predictable effect may be an advantage, and that UFH may work comparably when kept consistently in range. The study was retrospective and done at two centers, so it shows association rather than proof of cause, and results may not apply everywhere.
Galecio-Castillo M, Rodriguez-Calienes A, Cruz-Criollo L, Shaban A, Smith B, Torner J, et al.. (2026). Comparison of Unfractionated Heparin and Low-Molecular-Weight Heparin in Acute Cerebral Venous Thrombosis: A Subanalysis of the CLOT-VENUS Registry.. Journal of the American Heart Association. https://doi.org/10.1161/JAHA.125.046001