Cerebral venous thrombosis in COVID-19-associated coagulopathy: A case report

ObjectivesCurrent guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT.Data sourcesMEDLINE, Embase and COCHRANE databases up to 18 November 2020.Eligibility criteriaAll published articles of patients with CVT treated with DOAC were included. Studies without follow-up information were excluded.Data extraction and synthesisTwo independent reviewers screened articles and extracted data. A risk of bias analysis was performed.Primary and secondary outcome measuresSafety data included mortality, intracranial haemorrhage (ICH) or other adverse events. Efficacy data included recurrent CVT, recanalisation rates and disability by modified Rankin Scales (mRS).Results33 studies met inclusion criteria. One randomised controlled trial, 5 observational cohorts and 27 case series or studies reported 279 patients treated with DOAC for CVT: 41% dabigatran, 47% rivaroxaban, 10% apixaban and 2% edoxaban, in addition to 315 patients treated with standard therapy. The observational cohorts showed a similar risk of death in DOAC and standard therapy arms (RR 2.12, 95% CI 0.29 to 15.59). New ICH was reported in 2 (0.7%) DOAC-treated patients and recurrent CVT occurred in 4 (1.5%). A favourable mRS between 0 and 2 was reported in 94% of DOAC-treated patients, more likely than standard therapy in observational cohorts (RR 1.13, 95% CI 1.02 to 1.25).ConclusionThe evidence for DOAC use in CVT is limited although suggests sufficient safety and efficacy despite variability in timing and dose of treatment. This systematic review highlights that further rigorous trials are needed to validate these findings and to determine optimal treatment regimens.

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“…Two of the reported patients developed CVT in the context of COVID-19 infection and recovered without neurological sequelae. 45 46 …”

Section: Resultsmentioning

confidence: 99%

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

et al. 2021

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“…A cumulative data was defined as an amalgam of the current series and the previously reported cases [6][7][8][9][10][11][12][13][14][15][16][17][18]. A comparison between this cumulative data and some large-volume CVST studies performed before the COVID-19 pandemic [1,3,4,21,22], has been made ( Table 3).…”

Section: Resultsmentioning

confidence: 99%

“…This study represents a case series of CVST associated with SARS-CoV-2 infection, diagnosed and treated at multiple institutions throughout Iran. We provided a brief overview of all previously reported cases in Table 2 as well [6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

“…Since the evolution of the Coronavirus Disease 2019 (COVID-19) pandemic, non-respiratory manifestations of the disease like neurological manifestations [5] and thrombotic events have been progressively appreciated. Although there are some case reports and one case series [6][7][8][9][10][11][12][13][14][15][16][17][18] showing the association of the CVST and SARS-CoV-2 infection, the data about diagnosis and prognosis in this association is still limited. We investigated the demographic, clinical, radiological, and prognostic characteristics of this association to improve the diagnosis and treatment of patients with CVST and COVID-19.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Venous Sinus Thrombosis Associated with COVID-19: A Case Series and Literature Review

Ostovan

Foroughi

Rostami

et al. 2020

Preprint

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Background: Since the COVID-19 pandemic, several cases of cerebral venous sinus thrombosis (CVST) have been reported in SARS-CoV-2 infected individuals. This study provides a series of patients with CVST and SARS-CoV-2 infection.Methods: Consecutive patients with documented SARS-CoV-2 infection, as well as clinical and radiological characteristics of CVST, were reported from three teaching hospitals in the South West, North West, and the center of Iran from June to July 2020. We also searched the abstract archives until the end of August 2020 and gathered 28 reported cases. The diagnostic criteria for SARS-CoV-2 infection were determined according to SARS-CoV-2 detection in oropharyngeal or nasopharyngeal samples in clinically suspected patients. Demographics, main COVID-19 symptoms, confirmatory tests for SARS-CoV-2 infection diagnosis, the interval between the diagnosis of SARS-CoV-2 infection and CVST, clinical and radiological features of CVST, therapeutic strategies, CVST outcomes, rate of hemorrhagic transformation, and mortality rate were investigated.Results: Six patients (aged 31 to 62 years old) with confirmed CVST and SARS-CoV-2 infection were admitted to our centers. Four patients had no respiratory symptoms of SARS-CoV-2 infection. Five out of six patients developed the clinical manifestations of CVST and SARS-CoV-2 infection simultaneously. Three patients had known predisposing factors for CVST. Despite receiving CVST and SARS-CoV-2 infection treatments, four out of six patients passed away.Conclusions: The role of SARS-CoV-2 as a “cause” versus an “additive contributor” remains to be elucidated. Practitioners should be aware of the possibility of CVST in SARS-CoV-2 infection.

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“…Therefore, we believe a more appropriate action would be to discontinue any forms of combined hormonal contraceptives in patients with suspected or confirmed COVID-19. In fact, cases of cerebral venous thrombosis which are potentially fatal have been reported in patients with COVID-19, and the most frequent risk factor for cerebral venous thrombosis identified in young women is the use of combined oral contraceptives [9,10].…”

Section: The Use Of Combined Hormonal Contraceptives Amid the Covid-1mentioning

confidence: 99%

The use of combined hormonal contraceptives amid the COVID-19 pandemic

Kow

Mustafa

Hasan

2020

The European Journal of Contraception & Reproductive Health

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Cerebral venous thrombosis in COVID-19-associated coagulopathy: A case report

Cited by 33 publications

References 6 publications

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

Cerebral Venous Sinus Thrombosis Associated with COVID-19: A Case Series and Literature Review

The use of combined hormonal contraceptives amid the COVID-19 pandemic

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