An Observational Study Comparing the Safety and Efficacy of Conventional Anticoagulation Versus New Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis

Shahid, Rizwana; Zafar, Azra; Nazish, Saima; Alshamrani, Foziah; Ishaque, Noman; Alabdali, Majed; Albakr, Aishah; Jaafari, Danah Al; Al-Khamis, Fahd A; Shariff, Erum; Soltan, Nehad Mahmoud; Saqqur, Maher

doi:10.4088/pcc.21m02927

Cited by 5 publications

(25 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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).…”

Section: Summary Of Search and Screeningmentioning

confidence: 99%

“…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.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…For instance, 2 studies defined it as bleeding resulting in a reduction in hemoglobin of at least 2 g/dL or requiring 2 or more PRBC transfusion or bleeding in a critical organ, 17,33 one as nontraumatic symptomatic intracranial hemorrhage or bleeding resulting in the need for transfusion of 2 or more units of blood, the need for hospitalization or prolongation of an existing hospitalization, or death, 13 and one as any intracranial hemorrhage or extracranial bleeding resulting in the need for transfusion or 2 or more units of blood. 23 In the other studies, 12,32,34,38 there was no definition provided.…”

Section: Major Hemorrhagementioning

confidence: 99%

See 2 more Smart Citations

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

Yaghi

Saldanha

Misquith

et al. 2022

Stroke

View full text Add to dashboard Cite

BACKGROUND: High level evidence for direct oral anticoagulants (DOACs) in patients with cerebral venous thrombosis is lacking. We performed a systematic review and meta-analysis to assess the efficacy and safety of DOACs versus vitamin K antagonists in patients with cerebral venous thrombosis. METHODS: This systematic review was registered in PROSPERO (CRD42021228800). We searched MEDLINE (via Ovid), EMBASE, CINAHL, and the Web of Science Core Collection between January 1, 2007 and Feb 22, 2022. Search terms included a combination of keywords and controlled vocabulary terms for cerebral venous thrombosis, vitamin K antagonists/warfarin, and DOACs. We included both randomized and nonrandomized studies that compared vitamin K antagonists and DOACs in 5 or more patients with cerebral venous thrombosis. Where studies were sufficiently similar, we performed meta-analyses for efficacy (recurrent venous thromboembolism and complete recanalization) and safety (major hemorrhage) outcomes, using relative risks (RRs). RESULTS: Out of 10 665 records identified, we screened 254 as potentially eligible. Nineteen studies (16 observational studies [n=1735] and 3 randomized controlled trials [n=215]) met the inclusion criteria. All 3 randomized controlled trials had some concerns, and all 16 observational studies had at least moderate risk of bias. When compared with vitamin K antagonist treatment, DOAC had comparable risks of recurrent venous thromboembolism (relative risk [RR], 0.85 [95% CI, 0.52–1.37], I 2 =0%), major hemorrhage (RR, 0.70 [95% CI, 0.40–1.21], I 2 =0%), intracranial hemorrhage (RR, 0.58 [95% CI, 0.30–1.12]; I 2 =0%), death (RR, 1.14 [95% CI, 0.54–2.43], I 2 =1%), and complete venous recanalization (RR, 0.98 [95% CI, 0.87–1.11]; I 2 =0%). CONCLUSIONS: This systematic review and meta-analysis suggest that in patients with cerebral venous thrombosis, DOACs, and warfarin may have comparable efficacy and safety. Given the limitations of the studies included (low number of randomized controlled trials, modest total sample size, rare outcome events), our findings should be interpreted with caution pending confirmation by ongoing randomized controlled trials and large, prospective, observational studies.

show abstract

Section: Summary Of Search and Screeningmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Major Hemorrhagementioning

confidence: 99%

See 1 more Smart Citation

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

Yaghi

Saldanha

Misquith

et al. 2022

Stroke

View full text Add to dashboard Cite

show abstract

“…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 .…”

Section: Study Selection Criteriamentioning

confidence: 99%

“…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 .…”

Section: Introductionmentioning

confidence: 99%

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

Ranjan,

Ken‐Dror,

Sharma

2024

Health Science Reports

View full text Add to dashboard Cite

ObjectivesWe compared the safety and efficacy of direct oral anticoagulants (DOACs) with those of warfarin in the long‐term (≥6 months) treatment of cerebral venous thrombosis (CVT).MethodsWe searched electronic databases up to November 2023 to compare the use of DOACs and warfarin in CVT management. Modified Rankin scores (mRS), new intracranial hemorrhage, all‐cause mortality, recurrence and nonrecanalisation events were used to assess outcome. RevMan v5.4 software and the Cochran‐Mantel‐Haenszel method were utilized to analyse data.ResultsA total of 25 studies involving 2301 patients were identified as having treated CVT with either DOACs or warfarin. Good long‐term mRS scores 0–2 (risk ratio [RR] = 1.01, 95% CI = 0.98–1.03; p = 0.61), new intracranial hemorrhage (RR = 1.00, 95% CI = 0.48–2.08; p = 0.99), all‐cause mortality (RR = 1.00, 95% CI = 0.50–1.98; p = 0.99), nonrecanalisation (RR = 0.95, 95% CI = 0.77–1.18; p = 0.65) and recurrence venous thrombosis events (RR = 0.63, 95% CI = 0.33–1.22; p = 0.17) were similar between the two treatment arms. Subgroup analysis found recurrence of venous thrombosis was lower in the rivaroxaban group compared to warfarin (2.2% vs. 8.5%, RR = 0.33, 95% CI = 0.11–0.98; p = 0.05).ConclusionDOACs and warfarin provide comparable long‐term safety and efficacy profiles. DOACs may be preferred over warfarin due to their ease of clinical management.

show abstract

Efficacy and Safety of Direct Oral Anticoagulants in Cerebral Venous Thrombosis: Meta-Analysis of Randomized Clinical Trials

Chen,

Guo,

Lin

2024

Clin Appl Thromb Hemost

View full text Add to dashboard Cite

Current guidelines recommend the standard-of-care anticoagulation (vitamin K antagonists or low-molecular-weight heparin) in patients with cerebral venous thrombosis (CVT). Herein, we performed a meta-analysis of randomized clinical trials (RCTs) to assess the efficacy and safety of direct oral anticoagulants (DOACs) compared with the current standard of care in patients with CVT. We systematically searched the PubMed and Embase databases up to December 2023 to identify clinical trials on the effect of DOACs in patients with CVT. A Mantel-Haenszel fixed effects model was applied, and the effect measures were expressed as the absolute risk differences (RDs) and 95% confidence intervals (CIs). A total of 4 RCTs involving 270 participants were included. In the pooled analysis, DOACs and standard of care had low incidence rates of recurrent VTE and all-cause death, and similar rates of any recanalization (78.2% vs 83.2%; RD = −4%, 95%CI:−14% to 5%) and complete recanalization (60.9% vs 69.4%; RD = −7%, 95%CI:−24% to 10%). Compared with the standard of care, DOACs had non-significant reductions in the rates of major bleeding (1.2% vs 2.4%; RD = −1%, 95%CI: −6% to 3%), intracranial hemorrhage (1.9% vs 3.6%; RD = −2%, 95%CI:−7% to 3%), clinically relevant non-major bleeding (3.8% vs 7.4%; RD = −4%, 95%CI:−9% to 2%), and any bleeding (17.3% vs 21.4%; RD = −4%, 95%CI:−16% to 8%) in patients with CVT. DOACs and standard of care showed similar efficacy and safety profiles for the treatment of CVT. DOACs might be safe and a convenient alternative to vitamin K antagonists for thromboprophylaxis in patients with CVT.

show abstract

An Observational Study Comparing the Safety and Efficacy of Conventional Anticoagulation Versus New Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis

Cited by 5 publications

References 0 publications

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

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

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

Efficacy and Safety of Direct Oral Anticoagulants in Cerebral Venous Thrombosis: Meta-Analysis of Randomized Clinical Trials

Contact Info

Product

Resources

About