Abstract
Use of Direct Oral Thrombin Inhibitors for Cerebral Venous Thrombosis
Neurosurgery, v 67(Supplement_1)
01 Dec 2020
Abstract
INTRODUCTION Cerebral venous thrombosis (CVT) is an uncommon medical emergency that affects an estimated 1 in 100,000 patients per year1. Acute phase treatment of CVT involves the use of either intravenous (IV) unfractionated heparin or subcutaneous low molecular weight heparin (LMWH). Long term anticoagulation typically employs the use of Vitamin K antagonists (VKA) such as warfarin which is cumbersome to manage due to multiple drug and dietary interactions, need for constant monitoring, and further bleeding complications3,4,5. Direct oral anticoagulants (DOACs) have been shown to be a safer alternative for recurrent venous thromboembolism with less incidence of intracranial and extracranial hemorrhagic complications.3,7 METHODS This is a retrospective review of 8 patients diagnosed with CVT treated with rivaroxaban, a factor Xa inhibitor. Outcomes including further thrombotic as well as hemorrhagic complications were reviewed. RESULTS Eight patients with the diagnosis of CVT who were treated with rivaroxaban were identified. Seven patients were initially treated with unfractionated heparin, and then placed on long-term anticoagulation with rivaroxaban, while one patient was started on rivaroxaban without an IV heparin bridge. Seven patients were treated successfully with recanalization or stable chronic occlusion with collateralization at 6 months. One patient had worsening symptomatic progression, was switched to enoxaparin, had further progression and required endovascular intervention. One patient experienced menorrhagia. There were no further bleeding complications. CONCLUSION This series suggests that DOACs can be safely used for the treatment of CVT in most patients with acceptable outcomes. Prospective studies with longer-term follow-up are necessary to confirm this finding.
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Details
- Title
- Use of Direct Oral Thrombin Inhibitors for Cerebral Venous Thrombosis
- Creators
- Hirad Hedayat - Oxford University PressNatalie Gofman - Oxford University PressAbhijith Bathini - Oxford University PressRandall Faber - Oxford University PressMandy Binning - Oxford University Press
- Publication Details
- Neurosurgery, v 67(Supplement_1)
- Publisher
- Wolters Kluwer Health, Inc
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- Neurology
- Other Identifier
- 991021917817704721