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 ... -  《-》

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 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 ... -  《-》

Use of direct oral anticoagulants in cerebral venous thrombosis: a systematic review.

Sheng S ，Nalleballe K ，Pothineni NV ，Sharma R ，Brown A ，Elkhider H ，Ranabothu S ，Kapoor N ，Patrice KA ，Onteddu S ... -  《-》

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 ... -  《-》