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 ... -  《-》

Preliminary findings regarding the use of direct oral anticoagulants in cerebral venous thrombosis.

Direct oral anticoagulants (DOACs) have entered the treatment paradigms of various conditions based upon large randomized controlled trials. However, use of DOACs for thrombosis at unusual sites, such as cerebral venous thrombosis (CVT), is less clear as the ability to conduct large randomized controlled trials is limited by its rarity. Furthermore, its use in the setting of malignancy or in the elderly remains an area of ongoing research. Our aim was to assess the outcomes in CVT patients treated with DOACs compared to warfarin. We also sought to elucidate whether its use was safe in the setting of malignancy or in the elderly. Retrospectively assess the differences in clinical outcomes in patients hospitalized with CVT in the Lifespan Health System. Between 1 July 2004 and 1 March 2020, 46 adult patients with CVT fulfilled inclusion criteria. No significant differences in outcomes were observed between the DOAC (N = 8) and vitamin K antagonist (VKA) (N = 38) cohorts. The use of DOACs did not result in an increased rate of acute complications, recurrent venous thromboembolism (VTE) and/or CVT, World Health Organization (WHO) grade 3 or 4 bleeding rates, or differences in clinical improvement per the modified Rankin scale. Furthermore, in patients with underlying metastatic cancer (N = 2) or in patients > 80 (N = 1) who received a DOAC, there was no increase in adverse events or significant differences in outcome when compared to warfarin. Patients who received a DOAC in the treatment of CVT demonstrated no differences in outcomes when compared to warfarin.

Hsu A ，Mistry H ，Lala N ，Reagan JL ... -  《-》

Is it safe to treat cerebral venous thrombosis with oral rivaroxaban without heparin? A preliminary study from 20 patients.

Newer oral anticoagulants like rivaroxaban are increasingly becoming the mainstay of treatment in systemic thrombosis. However cerebral venous thrombosis (CVT) is conventionally treated with heparin followed by oral vitamin K antagonists. Currently very little information is available about the use of rivaroxaban in CVT. Rivaroxaban has been used only after the initial treatment with heparin in the available studies. All patients with CVT between January 2017 and June 2017 were initiated directly on oral rivaroxaban. Critically ill patients including those requiring surgical intervention were excluded. The modified Rankin scale was used to assess clinical severity and a scale of 0-1 was defined as excellent outcome. Recanalization was assessed at 3 months follow-up with MR angiography. Complications of the drug including bleeding episodes during treatment and at follow-up were noted. Twenty patients were initiated on rivaroxaban and followed up for a mean duration of 6 months. Eighty percent (16/20) were males and the mean age was 34.1 years. Associated cerebral hemorrhagic infarcts were seen in 11(55%).Outcome was excellent in 19(95%). Complete recanalization was noted in 12(60%) and partial recanalization in 8(40%). No complications emerged out of the drug use. In clinically stable CVT rivaroxaban is safe and effective and may be used without previous heparin therapy. This can shorten the duration of hospitalization thereby decreasing the costs of treatment.

Shankar Iyer R ，Tcr R ，Akhtar S ，Muthukalathi K ，Kumar P ，Muthukumar K ... -  《-》

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 ... -  《-》

Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis.

Lee GKH ，Chen VH ，Tan CH ，Leow AST ，Kong WY ，Sia CH ，Chew NWS ，Tu TM ，Chan BPL ，Yeo LLL ，Sharma VK ，Tan BYQ ... -  《-》