Apixaban for the treatment of cerebral venous thrombosis: A case series.

Venous thrombosis affecting cerebral veins and sinuses (CVT) is an uncommon neurological condition. Traditionally patients are treated with intravenous heparin followed by an oral vitamin K antagonist like warfarin. Direct oral anticoagulants (DOACs) may offer advantages over warfarin. There is evidence to demonstrate the effectiveness of both dabigatran and rivaroxaban. No data, however, has been published describing the use of apixaban in patients with CVT. Report of three cases of CVT and review literature on available treatment options; efficacy and safety of novel oral anticoagulants in patients with systemic thrombosis. All patients presented with typical features of CVT. After confirming the diagnosis, they were acutely treated with heparin and later discharged on apixaban. During follow up visits, they tolerated apixaban well and did not have any bleeding complications. Follow up scans showed resolution of the thrombus and recanalization. CVT is an uncommon neurological condition and is often complicated by associated intraparenchymal hemorrhage. Although not recommended in current guidelines, apixaban may be a safe and effective option for the treatment of CVT.

Rao SK ，Ibrahim M ，Hanni CM ，Suchdev K ，Parker D ，Rajamani K ，Mohamed W ... -  《-》

Direct Oral Anticoagulants for the Treatment of Cerebral Venous Thrombosis.

Cerebral venous thrombosis (CVT) is an uncommon neurological condition usually treated with heparin followed by oral vitamin K antagonists (VKAs). In patients with venous thromboembolism (VTE), compared to VKAs, direct oral anticoagulants (DOACs) offer several advantages. However, there is little data concerning their use in managing CVT. This retrospective observational study pursued 2 objectives: (1) to investigate clinical characteristics of CVT patients treated with heparin + DOACs vs. heparin + standard treatment; (2) to compare clinical outcomes. Consecutive CVT patients recruited from January 2016 to March 2018 in 2 French university hospitals (Lyon, Saint-Etienne), and treated with DOACs or VKAs were identified. Radiological evolution, VTE, hemorrhagic events, and antithrombotic medication were recorded. Functional outcome was assessed by the modified Rankin scale score and venous recanalization was assessed by magnetic resonance imaging. Overall, 41 patients were included: 25 (61%) received VKAs and 16 (39%) DOACs. We identified no clinical or radiological features explaining the physicians' preference for a specific anticoagulation treatment, and age, initial clinical presentation, radiological severity, and individual risk factors thus unlikely guided the choice of anticoagulant. No DOAC patient exhibited clinical or radiological thrombosis aggravation, and the thrombosis completely vanished in 6 (40%). Two of the VKA-treated patients (28.6%) demonstrated complete venous recanalization, whereas 3 others experienced clinical or radiological aggravation versus baseline. There was no major bleeding leading to hospitalization in both groups. The collected data on DOAC efficacy and safety in CVT management appear encouraging, yet needs to be confirmed by larger prospective randomized clinical trials.

Lurkin A ，Derex L ，Fambrini A ，Bertoletti L ，Epinat M ，Mismetti P ，Dargaud Y ... -  《-》

Direct oral anticoagulants in rare venous thrombosis.

Finazzi G ，Ageno W 《-》

Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study.

Yaghi S ，Shu L ，Bakradze E ，Salehi Omran S ，Giles JA ，Amar JY ，Henninger N ，Elnazeir M ，Liberman AL ，Moncrieffe K ，Lu J ，Sharma R ，Cheng Y ，Zubair AS ，Simpkins AN ，Li GT ，Kung JC ，Perez D ，Heldner M ，Scutelnic A ，Seiffge D ，Siepen B ，Rothstein A ，Khazaal O ，Do D ，Kasab SA ，Rahman LA ，Mistry EA ，Kerrigan D ，Lafever H ，Nguyen TN ，Klein P ，Aparicio H ，Frontera J ，Kuohn L ，Agarwal S ，Stretz C ，Kala N ，El Jamal S ，Chang A ，Cutting S ，Xiao H ，de Havenon A ，Muddasani V ，Wu T ，Wilson D ，Nouh A ，Asad SD ，Qureshi A ，Moore J ，Khatri P ，Aziz Y ，Casteigne B ，Khan M ，Cheng Y ，Mac Grory B ，Weiss M ，Ryan D ，Vedovati MC ，Paciaroni M ，Siegler JE ，Kamen S ，Yu S ，Leon Guerrero CR ，Atallah E ，De Marchis GM ，Brehm A ，Dittrich T ，Psychogios M ，Alvarado-Dyer R ，Kass-Hout T ，Prabhakaran S ，Honda T ，Liebeskind DS ，Furie K ... -  《-》

The use of direct oral anticoagulants in 56 patients with antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is a common acquired thrombophilia associated with a high thrombotic risk, in which vitamin K antagonists (VKA) represent the mainstay of therapy. Case series involving up to 35 patients with APS suggested limited efficacy and safety of direct oral anticoagulants (DOACs). In the prospective case series we followed 56 consecutive patients with APS (44 women and 12 men, aged from 22 to 64years), including 33 (60%) associated with systemic lupus erythematosus (SLE) and 16 (28.6%) with triple APS who were treated with DOACs due to their preferences or unstable anticoagulation with VKA. DOACs were started at least 3months since the thromboembolic event in patients with D-dimer below 500ng/ml. Forty-nine (87.5%) patients were treated with rivaroxaban, 4 (7.3%) with dabigatran and 3 (5.4%) with apixaban. During follow-up of 2 to 43 (mean 22) months, 6 (10.7%, 5.8 per 100 patient-years) patients (4 women and 2 men, 4 with triple positive APS) experienced recurrent thrombosis, including deep vein thrombosis (n=4, including 2 episodes preceded by nonadherence), superficial vein thrombosis (n=1) and non-ST elevation myocardial infarction (n=1). The recurrence rate of VTE on DOACs was 5.8 per 100 patient-years. Two patients (3.6%) experienced severe bleeding. This case-series suggests that DOACs are safe in patients with APS. These findings need to be confirmed in larger studies.

Malec K ，Góralczyk T ，Undas A 《-》