CCM: Efficacy and safety of a novel oral anticoagulant for cerebral sinus thrombosis

2022-04-26 0 By

Cerebral venous sinus thrombosis (CVT) is a relatively rare thrombotic disorder with an incidence of 3-15 cases per million person-years.Following diagnosis, current guidelines recommend treatment with parenteral heparin in the acute phase, followed by a transition to oral anticoagulant therapy with vitamin K antagonists (VKAs) for 3-12 months, depending on the clinical situation.Despite clinical trial evidence of non-vitamin K antagonist oral anticoagulants,NOACs has been widely used in the treatment of systemic Venous thromboembolism (VTE), but its application data in CVT are still lacking.Therefore, NOAC is not currently recommended to treat CVT.A recent randomized controlled trial comparing dabigatran with an adjusted dose of warfarin found that both groups had a fairly low risk of recurrent VTE and similar bleeding rates.Several small case series have also shown similar clinical and radiographic outcomes between Dabigatran and VAK.The evidence used for Rivaroxaban and Apixaban is still limited to a small case series, again suggesting comparable regenerative rates between these NOAC and VKA.In December 2021, James A. Giles et al., USA, reported in Neurocrit Care A single-center retrospective cohort study comparing patients with CVT treated with NOACs (the largest number of patients treated with apixaban in this case series) with patients treated with VKAs.Twenty-nine CVT patients treated with NOAC were followed up in 27 of them.NOAC included apixaban (20 patients), rivaroxaban (6 patients), and Dabigatran (1 patient).During a median follow-up period of 6 months, 55.6% of NOAC patients achieved thrombus stabilization or partial recanalization and 14.8% achieved complete recanalization.At follow-up, the median mRS was 0, and 1 patient died.Severe bleeding complications occurred in three patients (11.1%), and intracranial bleeding symptoms worsened in two of them.Partial recanalization (55.6% vs 63.0%, P =0.29), complete recanalization (14.8% vs 25.9%, P =0.73), mRS at follow-up (median 0 vs 0, P =0.23), or major bleeding (11.1% vs 11.1%, p=0.23) compared with 27 age-matched and sex-matched controls who received VKAs.p>0.99) has no significant difference.Comparison with historical International Study on Cerebral Vein and Dural Sinus Depletion queue shows similar functional outcomes:Washington University School of Medicine, St. Louis, 92.6% of patients treated with NOACs and 88.9% of patients treated with VKAs;And the historical study cohort, 86.2% of patients who received VKAs had mRS 0-2 at follow-up (P =0.60).Rates of major bleeding were also similar compared to this cohort (11.1% vs 11.1% vs 14.5%, P =0.80).The authors conclude that the safety and efficacy of NOAC is similar to that of VKAs in age – and sex-matched controls and historically in CVT.It is necessary to evaluate the efficacy and safety of NOAC in CVT in multicenter cohort studies and randomized controlled trials.Neurocrit Care. 2021 Dec;35(3):783-788. doi: Epub 2021 May 27. Non-vitamin K Antagonist Oral Anticoagulants for the Treatment of Cerebral Venous Sinus Thrombosis: A Retrospective, Matched Cohort Analysis statement: This article copyright belongs to the original author, if there is a source error or infringement of your legitimate rights and interests, you can contact us through email, we will deal with in a timely manner.Email address: jpbl@jp.jiupainews.com