Low Molecular Weight Heparin Initiated 3 Hours After Venous Sinus Stenting May Reduce Bleeding Risk in Patients with Cerebral Venous Sinus Stenosis

OBJECTIVE: This study aimed to assess whether the timing of low molecular weight heparin (LMWH) initiation after venous sinus stenting affects early hemorrhagic risk in patients with cerebral venous sinus stenosis (CVSS). METHODS: This single-center, real-world study consecutively enrolled CVSS patients at the subacute or chronic stage who underwent venous sinus stenting from January 2017 to July 2023. Based on the timing of LMWH initiation, patients were categorized into 2 groups: the immediate poststenting group and the third-hour poststenting group. Clinical characteristics, coagulation parameters, computed tomography imaging, and available follow-up data were compared. RESULTS: A total of 105 eligible patients (median age 37.0 years; 75 females and 30 males) were included in the analysis. Among them, 46 patients received immediate LMWH initiation, while 59 received LMWH 3 hours poststenting. Across all patients, postoperative coagulation parameters [e.g., activated partial thromboplastin time, prothrombin time, thrombin time, fibrinogen] changed significantly compared with baseline (all P < 0.001). Notably, activated partial thromboplastin time at 3 hours poststenting was significantly lower in the third-hour group than in the immediate group [73.20 (67.40-81.30) s versus 84.35 (80.13-93.23) s, P < 0.001]. The immediate group had a higher incidence of symptomatic intracranial hemorrhage than the third-hour group (8.7% vs. 0.0%, P = 0.034). During follow-up, no stent-related stenosis, restenosis, or delayed bleeding were observed in either group. CONCLUSIONS: Delaying LMWH anticoagulation until 3 hours poststenting may effectively reduce bleeding risk in CVSS patients. These findings support optimizing early postoperative anticoagulation timing to enhance procedural safety and warrant validation in prospective studies.