Activated partial thromboplastin time as a predictor of hyperdense thrombus on non-contrast CT in acute cerebral venous sinus thrombosis

Abstract

Background and Aim: Cerebral venous sinus thrombosis (CVST) is an uncommon yet potentially serious cerebrovascular disorder that demands rapid diagnosis and timely treatment. Non-contrast computed tomography (NCCT) frequently shows increased thrombus attenuation, expressed in Hounsfield Units (HU), which mirrors clot composition. Activated partial thromboplastin time (APTT), a marker reflecting intrinsic coagulation pathway activity, may modulate thrombus formation dynamics. The relationship between APTT and thrombus density in acute CVST, however, has not been well characterized. We aimed to evaluate the association between APTT and HU-based thrombus density in patients with acute CVST. Methods: We conducted a retrospective cohort study at a tertiary referral center between January 2022 and December 2023. Adult patients with acute CVST who underwent NCCT within 7 days of symptom onset and had APTT measured within 24 hours of imaging were included. Thrombus density was measured in HU using standardized region-of-interest assessment. Spearman’s rank correlation was used to examine the APTT–HU relationship, and receiver operating characteristic (ROC) analysis was used to define the optimal APTT threshold for predicting higher thrombus density (HU ≥ 70). Results: Ninety-three patients were analyzed. A moderate negative correlation was observed between APTT and thrombus density (r = –0.408, p < 0.001). ROC analysis identified an APTT threshold of ≤21.6 seconds for predicting HU ≥ 70, with sensitivity 72.9%, specificity 91.1%, and an area under the curve of 0.769 (p < 0.001). Conclusion: Shorter APTT values are associated with denser thrombi on NCCT in acute CVST. Combining coagulation parameters with quantitative CT measurement may strengthen early evaluation and clinical decision-making, especially in centers with limited access to advanced venous imaging.

Access to Document

Other files and links

• Link to publication in Scopus
• Open Access Version Available

Fingerprint