clot in saggitial sinus vein

In October my 19 year old son had a clot in his sagittial sinus vein and is prothrombin II reactive, heteroygous with no other positive factors. He takes coumadin but his Pt/INR has dropped from 2.6 to 1.3. We have increased the dosage for three weeks and still have not reached theraputic levels again. Also, he is taking Keppra because the clot made him have a seizure. Another neurologist covering for our doctor said he did not need seizure medication now. How would you treat him?

[Dennis MD]

Hi.
If the desired INR is not reached with the present dose of coumadin, it is best to do dose adjustment.
With regards to the seizure medication, this is still controversial.  There are neurologists who will give seizure medication as prophylaxis until there is no more apparent pathology in the brain.  However, there are some who will not give any seizure medication unless the patient is having active seizures.