Introduction: Direct oral anticoagulants (DOACs) have gained popularity in treating cerebral venous thrombosis (CVT). However, studies comparing the use of DOACs to Vitamin K antagonists (VKA) among patients with CVT are limited. Methods: We conducted a single-center retrospective cohort study comparing VKA to DOAC-treated CVT patients. Clinical, radiographic findings and outcomes were compared. Continuous and categorical variables were compared using t-test or Wilcoxon test and Chi-square or Fisher's exact test, as appropriate. Results: 82 CVT patients were included in final analysis (mean age 41.3±16.3, 76.8% women). Thirty (37%) were treated with DOACs. There was no difference in clinical or radiographic characteristics between the two groups. There was no death and majority of patents were discharged home (p=0.11). Sixty-one patients (74.4%) had follow-up imaging within a year. Fifteen, thirty-seven and nine patients had complete, partial, and no vessel recanalization, respectively. There was no difference in recanalization status between the DOAC and VKA groups (p=0.53). 68 patients (82.3%) had follow-up data on headache status: 21(31%) reported resolution and 45(66%) partial improvement with no difference between DOAC and VKA groups (p=0.81). One patient in the DOAC group had a recurrent CVT. One patient in the VKA group had a major hemorrhage within 3 months. Conclusion: We found no significant difference in venous recanalization or outcomes in patients with CVT treated with DOAC vs VKA. DOAC appears to be a safe alternative to VKA. Large multicenter studies are needed to better evaluate the efficacy and safety of DOAC in CVT.
ObjectiveTo report a case of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis (AMPARE) as a potential immune-mediated complication of palbociclib (a cyclin-dependent kinase 4/6 inhibitor).BackgroundMedication-induced autoimmune encephalitis is an increasingly recognized entity. To date, cases have been reported with immune checkpoint inhibitors (ICIs), typically within 3 months and while cancer is responding to immunotherapy.ResultsA 55-year-old woman with metastatic breast cancer presented with new-onset neurologic symptoms. After diagnosis and treatment in 2008, she was in remission from 2010 to 2021. In April 2021, she developed metastatic recurrence. She started palbociclib in June 2021. PET scan in August 2021 showed improved metastases without new lesions. In September 2021, she developed encephalopathy, vertical nystagmus, and ataxia. Workup revealed AMPA-R antibodies. Palbociclib was stopped, and she received steroids, IVIg, and rituximab with marked improvement in her neurologic symptoms.DiscussionAMPARE is a well-described paraneoplastic syndrome. However, it is now understood that paraneoplastic syndromes can be driven by immunomodulatory medications, namely ICIs. Although palbociclib primarily prevents tumor proliferation, emerging data suggest that it may also be immunomodulatory. Given that our patient's AMPARE developed shortly after initiation of palbociclib while her cancer was responding to therapy, we postulate that it may have been unmasked by palbociclib, similarly to what has been reported with ICIs.
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