Background: A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants (DOACs) to warfarin in a real-world CVT cohort. Methods: This multicenter international retrospective study (United States, Europe, New Zealand) included consecutive patients with CVT treated with oral anticoagulation from January 2015 to December 2020. We abstracted demographics and CVT risk factors, hypercoagulable labs, baseline imaging data, and clinical and radiological outcomes from medical records. We used adjusted inverse probability of treatment weighted Cox-regression models to compare recurrent cerebral or systemic venous thrombosis, death, and major hemorrhage in patients treated with warfarin versus DOACs. We performed adjusted inverse probability of treatment weighted logistic regression to compare recanalization rates on follow-up imaging across the 2 treatments groups. Results: Among 1025 CVT patients across 27 centers, 845 patients met our inclusion criteria. Mean age was 44.8 years, 64.7% were women; 33.0% received DOAC only, 51.8% received warfarin only, and 15.1% received both treatments at different times. During a median follow-up of 345 (interquartile range, 140–720) days, there were 5.68 recurrent venous thrombosis, 3.77 major hemorrhages, and 1.84 deaths per 100 patient-years. Among 525 patients who met recanalization analysis inclusion criteria, 36.6% had complete, 48.2% had partial, and 15.2% had no recanalization. When compared with warfarin, DOAC treatment was associated with similar risk of recurrent venous thrombosis (aHR, 0.94 [95% CI, 0.51–1.73]; P =0.84), death (aHR, 0.78 [95% CI, 0.22–2.76]; P =0.70), and rate of partial/complete recanalization (aOR, 0.92 [95% CI, 0.48–1.73]; P =0.79), but a lower risk of major hemorrhage (aHR, 0.35 [95% CI, 0.15–0.82]; P =0.02). Conclusions: In patients with CVT, treatment with DOACs was associated with similar clinical and radiographic outcomes and favorable safety profile when compared with warfarin treatment. Our findings need confirmation by large prospective or randomized studies.

Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or “long-COVID” complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence.

Backgroundand Purpose: Cerebral venous thrombosis (CVT) is a rare cause of stroke carrying a nearly 4% risk of recurrence after 1 year. There is limited data on predictors of recurrent venous thrombosis in patients with CVT. In this study, we aim to identify those predictors.Methods:This is a secondary analysis of the ACTION-CVT study which is a multi-center international study of consecutive patients hospitalized with a diagnosis of CVT over a 6-year period. Patients with cancer associated CVT, CVT during pregnancy, or CVT in the setting of known antiphospholipid antibody syndrome were excluded per the ACTION-CVT protocol. The study outcome was recurrent venous thrombosis defined as recurrent venous thromboembolism (VTE) or de-novo CVT. We compared characteristics between patients with vs. without recurrent venous thrombosis during follow-up and performed adjusted Cox regression analyses to determine important predictors of recurrent venous thrombosis.Results:947 patients were included with a mean age was 45.2 years, 63.9% were women, and 83.6% had at least 3-months of follow-up. During a median follow-up of 308 (IQR 120-700) days, there were 5.05 recurrent venous thromboses (37 VTE and 24 de-novo CVT) per 100 patient-years. Predictors of recurrent venous thrombosis were Black race (adjusted HR 2.13, 95% CI 1.14-3.98, p = 0.018), prior history of VTE (aHR 3.40, 95% CI 1.80-6.42, p < 0.001) and the presence of one or more positive antiphospholipid antibodies (aHR 3.85, 95% CI 1.97-7.50, p < 0.001). Sensitivity analyses including events only occurring on oral anticoagulation yielded similar findings.Conclusion:Black race, history of VTE, and the presence of one or more antiphospholipid antibodies are associated with recurrent venous thrombosis among patients with CVT. Future studies are needed to validate our findings to better understand mechanisms and treatment strategies in patients with CVT.

Introduction: Evidence is unclear for invention in patients with a mild stroke (low NIHSS) and LVO (large vessel occlusion) as only 15-17 patients with NIHSS < 6 were included in the randomized trials. Cohort studies report good and poor outcomes in low NIHSS LVO cases, with some reporting poor complications secondary to complications and associated with burden of chronic illness. The THRIVE (Total Health Risk in Vascular Events) score was previously associated with poor outcomes in stroke patients. We hypothesized that the THRIVE score may be associated with poor outcomes in low NIHSS LVO patients. Methods: An IRB approved retrospective stroke study from January 2015 to December 2019 was used. Out of 2401 eligible acute ischemic stroke patients, 107 patients with an NIHSS < 6 with an LVO were included in the analysis. Non-parametric t-test, Chi-squared, and logistic regression were used for statistical analysis. Results: Of the 107 patients, the median age was 65 (55-74, interquartile range (IQR), 36% were female, 79% Caucasian, 44% had a discharge modified Rankin Score (mRS) of 0-1, 65% had a THRIVE score < 3, and time from LSN to presentation was 210 minutes (89 – 723 IQR). There was no difference in age, gender, race, time from LSN, or percent of patients with a THRIVE score < 3 (55% with IR vs 65% No IR). However, patients treated with a thrombectomy were significantly less likely to have a good neurologic outcome with discharge mRS of 0-1 if taken for thrombectomy (0% IR group versus 49% No IR, p=<0.0001). Of those taken for IR, 4 were basilar artery occlusions with poor outcomes, 4 MCA occlusions re-occluded post-IR were complicated by re-occlusion or high-grade stenosis. Notably, 54% had TTP lesions with cortex, but only 2 patients had significant cortical infarcts, and there was no symptomatic hemorrhagic conversion. Conclusion: Decision-making on IR for patients with low NHISS should be tailored to the patient, as it is likely that the inherent clinical factors prompting thrombectomy to be considered despite the low NIHSS are the important driving factors increasing the likelihood of worse outcomes. Further research is needed to evaluate the type of neurologic deficits and the eloquence of the tissue involved.