So, Dan, I would like to ask you if there is any aid, sex or ethnicity factors or even personal factors that Desper mentioned that would change your approach in the management of risk factors or patient treatment?

Yes, absolutely.

This is a very important question, but I think it is important to be precise about what we mean by personalization because the core principles of secondary prevention are the same for most patients.

So, as mentioned, we need to identify the stroke mechanism, we need to control blood pressure, we need to treat lipids, support smoking cessation, optimize diabetes management, physical activity, healthy diet, and so on.

So, what changes according to age, sex, or ethnicity is not if we address these risk factors, it is really how to prioritize them, how to communicate, and really how to tailor treatment to the individual patient.

So starting with age, because I agree this is particularly important and has been mentioned before, because we do distinguish older and younger patients in many ways, and it is an important part of personalization, I think.

So in older patients, we have strong evidence supporting secondary prevention, no doubt about it.

And if you encounter some of them, how would you be able to address them? So how were you addressing them to advocate for your patients?

So Diana, once the diagnosis is made, can you please walk us through the choices of anticoagulation and the therapies in that hyper-acute setting?

setting?Thank you for this question.

I think that's exactly the right place to start because once CVT is diagnosed, anticoagulation is the cornerstone of treatment, including in patients who already have an hemorrhagic transformation or an intracranial hemorrhage related to the CVT.

So in the hyperacute setting, we start usually with a therapeutic dose parenteral anticoagulation, and for most patients, that will mean low molecular weight heparin rather than unfractionated heparin.

And the reason is based on guideline recommendations and, uh, small trials and observational data that shows that low molecular weight heparin is probably easier to use, has a more predictable effect, and it, in these studies, it tends to be associated with better safety and, uh, clinical outcomes.

And still, unfractionated heparin, it is useful when we are thinking that a patient may need a procedure, for example, decompressive craniectomy, lumbar puncture, uh, that the patient may deteriorate quickly or if the patient has a contraindication, uh, like severe renal impairment.

And in these procedural situations, the, the reason is because it can be reversed very quickly, and that is, of course, an advantage.

Please comment on these, uh, therapies.