Ten years of cerebral venous thrombosis: male gender and myeloproliferative neoplasm is associated with thrombotic recurrence in unprovoked events

Abstract

Cerebral venous thrombosis (CVT) is a rare venous thrombotic event. We review our local experience in the management of CVT in comparison to other venous thromboembolism (VTE) with specific focus on risk factors for thrombotic recurrence. Retrospective evaluation of consecutive CVT presentations from January 2005 to June 2015, at two major tertiary hospitals in Northeast Melbourne, Australia. This population was compared to a separate audit of 1003 consecutive patients with DVT and PE. Fifty-two patients (30 female, 22 male) with a median age of 40 (18-83) years, presented with 53 episodes of CVT. Twenty-nine episodes (55 %) were associated with an underlying risk factor, with hormonal risk factors in females being most common. The median duration of anticoagulation was 6 months with 11 receiving life-long anticoagulation. Eighty-one percent had residual thrombosis on repeat imaging, which was not associated with recurrence at the same or distant site. Nine (17 %) had CVT-related haemorrhagic transformation with two resultant CVT-related deaths (RR 22.5; p = 0.04). All three VTE recurrences occured in males with unprovoked events (RR 18.2; p = 0.05) who were subsequently diagnosed with myeloproliferative neoplasm (MPN). Compared to the non-cancer VTE population, non-cancer CVT patients were younger, had similar rate of provoked events and VTE recurrence, although with significantly higher rate of MPN diagnosis (RR 9.30 (2.29-37.76); p = 0.002) CVT is a rare thrombotic disorder. All recurrences in this audit occurred in male patients with unprovoked events and subsequent diagnosis of MPN, suggesting further evaluation for MPN may be warranted in patients with unprovoked CVT.

Towards the genetic basis of cerebral venous thrombosis—the BEAST Consortium: a study protocol

“…8 There is a lack of data evaluating the risk of CVT recurrence, as well as whether the risk factors for CVT are similar to those for DVT and PE. One recent study has found that after a 10-year follow-up on patients with DVT and PE only 5.2% developed CVT, 9 while for patients with CVT only 5.8% developed DVT/PE later on. 10 Therefore, no significant link between CVT and DVT/PE has been found so far.…”

Cerebral Venous Thrombosis: What's New?

“…49 In adults, risk factors for recurrence of CVT are male gender, myeloproliferative diseases (polycythemia vera or essential thrombocythemia), prior venous thrombotic events, and severe thrombophilia. [50][51][52] Oral anticoagulation after the acute phase of CVT contributes to the prevention of further venous thrombotic events, including recurrence of CVT. However, there have been no randomized controlled trials or prospective controlled studies assessing optimal duration of oral anticoagulation in this setting.…”