New Oral Anticoagulants versus Warfarin for Cerebral Venous Thrombosis: A Multi-Center, Observational Study

Wasay, Mohammad; Khan, Maria; Rajput, Haris Majid; Farooq, Salman; Memon, Mohammed Ibrahim; Alrukn, Suhail; Malik, Abdul; Abd‐Allah, Foad; Shoaib, Raja Farhat; Shahid, Rizwana; Nishat, Sadia; Awan, Safia

doi:10.5853/jos.2019.00150

Cited by 49 publications

(115 citation statements)

References 10 publications

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“…The main studies evaluating the use of the DOACs in patients with CVT are summarized in Table 1. They were mainly small observational studies, either retrospective [36][37][38][39][40] or prospective [41][42][43], and there was only one RCT [44]. The number of patients treated with DOAC ranged from 6 [38] to 60 [44] patients.…”

Section: Treatmentmentioning

confidence: 99%

“…The average anticoagulant treatment duration ranged from 5 [44] to 12 [40] months. Three studies evaluated rivaroxaban [36,38,41], two dabigatran [37,44], and three cohorts included different DOACs [40,42,43]. In the majority of the studies, the DOAC were used after an initial treatment with UFH or LMWH [36,37,40,42,44] in order to achieve stable conditions.…”

Section: Treatmentmentioning

confidence: 99%

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Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Riva

Ageno

2020

JCM

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Cerebral vein thrombosis (CVT) and splanchnic vein thrombosis (SVT) are two manifestations of venous thromboembolism (VTE) at unusual sites. They have an incidence at least 25–50 times lower than usual site VTE, but represent true clinical challenges. Recent evidence on the epidemiology, risk factors, prognosis, and treatment of CVT and SVT has been published in the last two decades, thus contributing to a better understanding of these diseases. The improvement in imaging techniques and a higher degree of clinical suspicion may have led to the observed increased frequency, whereas a better knowledge of provoking mechanisms could have contributed to reducing the proportion of events classified as unprovoked or idiopathic (13–21% of CVT, 15–27% of SVT). Few small randomized clinical trials and a number of observational studies, although hampered by heterogeneous therapeutic approaches, shed light on the safety and effectiveness of anticoagulant therapy in these populations. However, there are still some grey areas that warrant future research. In this narrative review, we discuss recent advances and therapeutic challenges in CVT and SVT.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Riva

Ageno

2020

JCM

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“…Furthermore, another open-label comparative cohort of CVT confirmed the higher effectiveness and safety of NOACs (mainly Rivaroxaban and Dabigatran), compared to those reported for warfarin (72). Furthermore, an ongoing study of Rivaroxaban for Cerebral Venous Thrombosis trail (SECRET) has been designed to evaluate the efficacy of Rivaroxaban in CVT (73).…”

Section: Treatmentmentioning

confidence: 90%

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Paybast

Aghamiri

2020

J Vessel Circ

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Background and Aim: Cerebral venous thrombosis (CVT) is a relatively common disorder of the cerebral venous system accounting for less than 1% of all strokes with a higher prevalence in Iran. Despite the considerable advances in recent years, the diagnosis and treatment of CVT are still challenging predominantly in the emergency setting. Therefore, the present study sought to provide an update on the diagnosis and treatment of CVT. Materials and Methods: PubMed, Web of Science, Google Scholar, Scopus, Elsevier, and Iranian domestic scientific databases were searched within January 1, 2000, to July 1, 2020. In all the electronic databases, the keywords (in the title/abstract) of "cerebral vein thrombosis" OR "CVT" OR "Cerebral venous sinus thrombosis" OR "CVST" AND "risk factor", "diagnosis", "treatment", and "prognosis" were searched. The unrelated articles, studies not concerning humans or pediatric population, and case reports were excluded from the study. In addition, the articles related to CVT in association with coronavirus disease 2019 infection were excluded from the present review. Results: According to the findings of the present study, the diagnosis of CVT might be delayed due to a wide range of clinical manifestations from a subacute headache with or without the signs of intracranial hypertension to the acute focal neurologic deficit and even loss of consciousness. Although the diagnosis is typically based on brain magnetic resonance imaging and magnetic resonance venography, there has been evidence suggesting that the plain computed tomography markers with an attenuation value of > 60.4 Hounsfield unit (HU) and Hounsfield-hematocrit (H: H) ratio of > 1.42 are specific enough for the diagnosis regardless of confirmatory imaging, such as venography. Additionally, the usefulness of D-dimer is still debatable, and an unacceptable false-negative rate of up to 26% has been illustrated. In terms of therapeutic aspects, although warfarin is still the mainstay of treatment, there has been increasing interest in new oral anticoagulants with promising results in both thrombus recanalization and excellent functional recovery. Balloon angioplasty and mechanical thrombectomy might also be considered in severely progressive cases without response to conventional treatments. It is worth mentioning that even for those achieving favorable outcomes, CVT can remain a disabling condition leading to at least neuropsychiatric complaints. Conclusion: The CVT is a rare and important cause of stroke accounting for less than 5% of all strokes mainly affecting young females. With regard to the rarity of the disease and novelty of the therapeutic approaches, there is a long way to fully identify the best diagnostic and therapeutic approaches to the disease.

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“…Sample size calculation was performed using an online tool (www.clinc alc.com). Based on observational data and marketing analyses [16][17][18], we assumed the share of OAC medication in Saudi Arabia to be as follows: warfarin 50%, apixaban 15%, rivaroxaban 15%, dabigatran 15%, edoxaban 5% (i.e. 30% BID and 70% QD).…”

Section: Discussionmentioning

confidence: 99%

Patient-guided modifications of oral anticoagulant drug intake during Ramadan fasting: a multicenter cross-sectional study

Batarfi

Alenezi

Alshehri

et al. 2020

J Thromb Thrombolysis

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Fasting Ramadan is known to influence patients' medication adherence. Data on patients' behavior to oral anticoagulant (OAC) drug intake during Ramadan is missing. We aimed to determine patient-guided modifications of OAC medication regimen during Ramadan and to evaluate its consequences. A multicenter cross-sectional study conducted in Saudi Arabia. Data were collected shortly after Ramadan 2019. Participants were patients who fasted Ramadan and who were on long-term anticoagulation. Patient-guided medication changes during Ramadan in comparison to the regular intake schedule before Ramadan were recorded. Modification behavior was compared between twice daily (BID) and once daily (QD) treatment regimens. Rates of hospital admission during Ramadan were determined. We included 808 patients. During Ramadan, 53.1% modified their intake schedule (31.1% adjusted intake time, 13.2% skipped intakes, 2.2% took double dosing). A higher frequency of patient-guided modification was observed in patients on BID regimen compared to QD regimen. During Ramadan, 11.3% of patients were admitted to hospital. Patient-guided modification was a strong predictor for hospital admission. Patient-guided modification of OAC intake during Ramadan is common, particularly in patients on BID regimen. It increases the risk of hospital admission during Ramadan. Planning of OAC intake during Ramadan and patient education on the risk of low adherence are advisable.

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New Oral Anticoagulants versus Warfarin for Cerebral Venous Thrombosis: A Multi-Center, Observational Study

Cited by 49 publications

References 10 publications

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

Cerebral and Splanchnic Vein Thrombosis: Advances, Challenges, and Unanswered Questions

An Update on Diagnosis and Treatment of Cerebral Venous Thrombosis in Adults: A Narrative Review

Patient-guided modifications of oral anticoagulant drug intake during Ramadan fasting: a multicenter cross-sectional study

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