Rivaroxaban for the treatment of cerebral venous thrombosis: a single-center experience

Bajkó, Zoltán; Maier, Smaranda; Moţăţăianu, Anca; Filep, Rareș Cristian; Stoian, Adina; Andone, Sebastian; Bălaşa, Rodica

doi:10.1007/s13760-021-01651-z

Cited by 6 publications

(25 citation statements)

References 24 publications

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“…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: Summary Of Search and Screeningmentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

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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“…A total of 2142 CVT patients were evaluated for all‐cause mortality. Overall mortality was 2.6%, with observational cohorts all‐cause mortality being comparable (2.4% vs 2.7%, I 2 = 0%, p = 0.99; RR = 1.00, 95% CI = 0.50–1.98) among the DOACs and warfarin group patients (Figure ) 12,13,16–18,20,22,24 . The funnel plot showed no evidence of publication bias.…”

Section: Resultsmentioning

confidence: 93%

“…We identified a total of 2274 published articles, of which 25 studies (5 RCTs and 20 observational studies) involving 2301 CVT patients met our study inclusion criteria, illustrated in the PRISMA flow diagram (Figure 1). RCTs evaluated 370 patients (DOACs n = 200: warfarin n = 170) 6–10 while observational cohort studies comprised 1931 patients (DOACs; n = 699: warfarin n = 1232) 11–30 . Most common reasons for the exclusion of articles were duplication ( n = 115), studies not compatible with inclusion criteria ( n = 1967), and review articles ( n = 141).…”

Section: Resultsmentioning

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%

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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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Efficacy and safety of direct oral anticoagulants versus warfarin in the treatment of cerebral venous sinus thrombosis

Sadeghi Hokmabadi,

Daei Sorkhabi,

Sarkesh

et al. 2024

Acta Neurol Belg

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Rivaroxaban for the treatment of cerebral venous thrombosis: a single-center experience

Cited by 6 publications

References 24 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 versus warfarin in the treatment of cerebral venous sinus thrombosis

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