Abstract TMP82: Comparison Of Direct Oral Anticoagulants To Vitamin K Antagonists For Treatment Of Cerebral Venous Sinus Thrombosis

Abstract

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.

Direct Oral Anticoagulants Versus Vitamin K Antagonists in Cerebral Venous Thrombosis: A Systematic Review and Meta-Analysis

“…We excluded 235 of these articles; the most common reasons for exclusion were that studies did not compare our treatments of interest (n=122 studies), full texts were not available (n=31 studies), and studies enrolled fewer than 5 patients per group (n=26 studies). We therefore included 19 studies-3 RCTs 17,28,29 and 16 observational studies [12][13][14][15][16]23,[30][31][32][33][34][35][36][37][38][39] -in the systematic review (Figure 1).…”

“…We identified 3 RCTs 17,28,29 and 16 observational studies. [12][13][14][15][16]23,[30][31][32][33][34][35][36][37][38][39] Fifteen studies reported on recurrent VTE, 16 studies reported on major hemorrhage, 16 studies reported on intracranial hemorrhage, 14 studies reported on death, and 12 studies reported on recanalization. In all studies, all outcomes reported were not significantly different between the 2 groups, except for 1 study 23 where the risks of major hemorrhage and intracranial hemorrhage were lower with DOAC treatment.…”

Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis

“…The overall occurrence of nonrecanalisation events was 19.6% of 1371 CVT patients. The analysis yielded similar events between the DOACs and warfarin groups (19.4% vs. 19.7%, I 2 = 0%, p = 0.65; RR = 0.95, 95% CI = 0.77–1.18) (Figure ) 7,10–12,14–16,18,19,21,23–25,28,29 . Additionally, analysing only studies of adult CVT also observed identical findings between DOACs and warfarin groups (RR = 0.97, 95% CI = 0.77–1.21, p = 0.78, I² =0%) 7,11,12,14–16,18,19,21,23–25,28,29 .…”

“…We included randomized and observational prospective and retrospective cohort studies of CVT patients in all age groups that compared the long‐term anticoagulation effects of DOACs and warfarin 6–30 . We excluded case reports, case series, review papers, and studies based on phenprocoumon anticoagulant 32,33 .…”

“…Current guidelines suggest using systemic anticoagulant therapy with unfractionated or low molecular weight heparin followed by long‐term warfarin to improve recanalisation and prevent a recurrence 3–5 . Small numbers of randomized controlled trials and observational studies have suggested that direct oral anticoagulants (DOACs) are potentially a better alternative to warfarin, but most of these studies have been underpowered 6–30 . However, DOACs have several benefits, including improved patient compliance, ease of clinical management, lower risk of bleeding and fewer interactions 2–5 .…”