in adults showed a trend for better outcome in the treated
group [21], but the mortality was lower in this series, and there
were more patients with milder presentations in the placebo
arm. On the basis of these limited data, a Cochrane review
concluded that anticoagulation with heparin was safe and that
there was some evidence of a clinically important benefit [22].
Intravenous heparin should be the first-line treatment, even in
the presence of hemorrhagic infarction, provided there are no
general contraindications to its use. If the patient deteriorates
despite adequate heparinization, selective catheter-guided local
thrombolysis may be an option in spite of the increased hemorrhagic
risk. There have been several reports of thrombolysis
via selective catheterization of the occluded sinus [23–30].