Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis

Lee, Grace K.H.; Chen, Vanessa H.; Tan, C. B.; Leow, Aloysius Sheng‐Ting; Kong, Wan Yee; Sia, Ching‐Hui; Chew, Nicholas; Tu, Tian Ming; Chan, Bernard P.L.; Yeo, Leonard L.L.; Sharma, Vijay K.; Tan, Benjamin Yong‐Qiang

doi:10.1007/s11239-020-02106-7

Cited by 36 publications

(49 citation statements)

References 12 publications

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“…However, utilisation of DOAC in less severe CVT cannot be ruled out as a confounding factor since the observational cohorts did not have comparable standard treatment groups. A meta-analysis published by Lee et al 57 showed similar results to our review with no difference between DOAC or warfarin for recanalisation rates or major bleeding; however, their review analysed an 'excellent' mRS outcome of 0-1 and found no difference, while our study analysed a 'favourable' mRS of 0-2 and found a difference in the observational cohorts. The dichotomy of a favourable mRS has been debated, with mRS greater than two shown to be related to 1-year mortality, as well as being an independence cut-off for entry to certain endovascular trials.…”

Section: Discussionsupporting

confidence: 86%

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

et al. 2021

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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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Section: Discussionsupporting

confidence: 86%

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

et al. 2021

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“…At the meantime, a trend toward reducing hemorrhage events was also observed. The present results were similar to a published report by Lee et al (19). In our study, however, we included a new high-quality study and Since CVST is a rare type of stroke with relatively low morbidity, it is not surprising for the lack of high-quality studies due to the difficulty to collect enough cases in the context of CVST therapy.…”

Section: Discussionsupporting

confidence: 87%

“…As a result, the rates of bleeding events, recanalization, and excellent clinical outcome were comparable between patients in both groups (Figures 8-10), and the RRs of bleeding events, recanalization, and excellent clinical outcome were 1.00 (95% CI 0.49-2.05), 0.91 (95% CI 0.70-1. 19), and 1.03 (95% CI 0.91-1.17), respectively. No between-study heterogeneity was observed.…”

Section: Subgroup Comparison Of Noacs and Vkasmentioning

confidence: 96%

Comparison of Novel Oral Anticoagulants and Vitamin K Antagonists in Patients With Cerebral Venous Sinus Thrombosis on Efficacy and Safety: A Systematic Review

Yao

Liao

et al. 2020

Front. Neurol.

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Vitamin K antagonists (VKAs) are guideline-suggested subacute anticoagulants for cerebral venous sinus thrombosis (CVST), although there is potential hemorrhage risk in clinical use. In the last decade, novel oral anticoagulants (NOACs) have been applied as an alternative to VKAs in some kinds of thromboembolic diseases. Whether NOACs could replace VKAs in CVST treatment remains unclear. We conducted a comparison between the two types of medicines on efficacy and safety for the treatment of CVST based on the present clinical evidence from a literature search. Six studies [four retrospective studies, one prospective study, and 1 randomized clinical trial (RCT)] including 398 patients were included. Data suggested no significant difference between NOACs and VKAs in terms of recurrence of venous thrombotic events (VTEs) or death [risk ratio (RR) = 0.34, 95% confidence interval (CI) 0.06–1.98], partial recanalization (RR = 0.97, 95% CI 0.93–1.14), and overall hemorrhage events (RR = 0.86, 95% CI 0.47–1.58). In conclusion, the application of NOACs for CVST is similar to that of VKAs in terms of efficacy and safety.

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“…However, in this study the rates of MB during a median treatment duration of 8.5 months was high (three patients; 8.3%), even though none of the events was life threatening 55 . A recently published meta‐analysis of six studies comparing DOACs and VKAs highlighted similar rates of excellent functional outcome (81.8% vs 76.1%, respectively; risk ratio [RR], 1.02; 95% CI, 0.93‐1.13) and a nonsignificant trend toward lower MB in the DOAC group (1.32% vs 3.45%, respectively; RR, 0.44; 95% CI, 0.12‐1.59) 58 …”

Section: Cerebral Vein Thrombosismentioning

confidence: 96%

Direct oral anticoagulants for unusual‐site venous thromboembolism

Riva

Ageno

2021

Research and Practice in Thrombosis and Haemostasis

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Direct oral anticoagulants (DOACs) are currently the preferred oral anticoagulant treatment for most of the patients with deep vein thrombosis of the lower extremities and/or pulmonary embolism. DOACs have several advantages over vitamin K antagonists, such as availability of fixed dosages, fewer drug interactions, faster onset of action, shorter half‐life, and lower risk of major and intracranial bleeding. Although the evidence on the use of DOACs in patients with unusual‐site venous thromboembolism (VTE) is limited to a few, small randomized controlled trials, these drugs are increasingly used in clinical practice, and several observational cohort studies have been published recently. This narrative review will describe the latest evidence for the use of the DOACs in patients with thrombosis in atypical locations (splanchnic, cerebral, upper extremity, ovarian, and renal vein thrombosis) and will provide some practical advice for their use in patients with unusual‐site VTE.

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Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis

Cited by 36 publications

References 12 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

Comparison of Novel Oral Anticoagulants and Vitamin K Antagonists in Patients With Cerebral Venous Sinus Thrombosis on Efficacy and Safety: A Systematic Review

Direct oral anticoagulants for unusual‐site venous thromboembolism

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