Direct oral anticoagulants for the treatment of cerebral vein thrombosis

Capecchi, Marco; Abbattista, Maria; Simone, P. De; Artoni, Andrea; Gianniello, Francesca; Bucciarelli, Paolo; Paolucci, Aldo; Martinelli, Ida

doi:10.1016/j.thromres.2022.11.001

Cited by 4 publications

(39 citation statements)

References 10 publications

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“…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%

“…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%

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

Yaghi

Saldanha

Misquith

et al. 2022

Stroke

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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.

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Section: Major Hemorrhagementioning

confidence: 99%

Section: Summary Of Search and Screeningmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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

Yaghi

Saldanha

Misquith

et al. 2022

Stroke

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“…Finally, 23 studies were included in this systematic review (Table 1). [9][10][11][12]14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] No additional studies were identified from the reference lists of the included studies, from five systematic review/metanalysis [43][44][45][46][47] recently published on this topic and from searching the grey literature.…”

Section: Study Identification and Selectionmentioning

confidence: 99%

“…Two studies were RCTs 11,12 ; 21 were case series or cohort studies, 9,10,14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] of whom seven studies had a prospective design. 27,31,32,36,38,40,42 Four studies were multicentre.…”

Section: Study Characteristicsmentioning

confidence: 99%

Efficacy and safety of the direct oral anti‐coagulants in patients with cerebral vein thrombosis: A systematic review and meta‐analysis

et al. 2022

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Cerebral vein thrombosis (CVT) includes thrombosis occurring in the deep or superficial cerebral veins and in the dural venous sinuses. 1,2 CVT is considered an unusual location of venous thromboembolism (VTE), with an incidence of 1.3-1.6 cases per 100 000 persons per year. 3,4 With the advancement in neuroimaging and the appropriate treatment, CVT is nowadays diagnosed earlier and shows a good prognosis. More than 80% of CVT patients obtain partial or complete recanalization 5 and excellent neurological outcome. 6 During the acute phase, mortality is on average 5% and is mainly due to local complications, such as cerebral herniation. 7 In the latest guidelines of the European Stroke Organisation, published in 2017, vitamin K antagonists (VKAs) were still considered the standard oral

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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

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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.

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Direct oral anticoagulants for the treatment of cerebral vein thrombosis

Cited by 4 publications

References 10 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

Efficacy and safety of the direct oral anti‐coagulants in patients with cerebral vein 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

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