What would you recommend for long term management of extensive dural venous sinus thrombosis (CVST) in young females when the only provoking risk factor is combined OCP?  

From a Vascular Neurology perspective, there are two considerations when faced with patients with venous sinus thrombosis. First is the status of the intracranial venous circulation and whether or not there has been adequate reconstitution of venous outflow, either through recanalization or collater...

I would anticoagulate initially with a DOAC or warfarin. I would do follow-up imaging in 3-6 months, and if the CVST was significantly improved, switch to aspirin. If not, continue anticoagulation for a total of 12 months, then try discontinuing in favor of aspirin, after reimaging.

Practice guidelines from the AHA on CVT came out earlier this year:Saposnik et al., PMID 38284265