Abstract Number: PB2468
Meeting: ISTH 2020 Congress
Background: Cerebral vein thrombosis (CVT) is a rare and potentially fatal disorder. Patients with CVT can require extended anticoagulation.
Aims: Data on direct oral anticoagulants (DOACs) for the treatment for CVT are available but information on long-term outcomes is scanty.
Methods: In this case series, we report data on CVT patients consecutively referred to our clinics and prescribed with DOACs after an initial course of conventional treatment (UFH/LMWH ± vitamin K-antagonist/VKA). Data on clinical and radiological follow-up were collected approximately every 6-12 months according to scheduled visits. DOACs prescription for CVT is currently off label in Italy. All patients were properly informed and signed a consent.
Results: We report data on 10 CVT patients treated with DOAC. The mean age at diagnosis was 49±13 years (range, 21-65); 7 patients (70%) were female. Conditions predisposing to CVT were identified in 2 patients (i.e. neurosurgery and hormonal treatment, respecitvely), while CVT was unprovoked in 8/10 patients. DOACs treatment was started after a medium period of 12±15 months of conventional treatment. Dabigatran at highest available dosage was the preferred drug (7/10 patients), while rivaroxaban and apixaban were used in a minority of patients. Four out of ten patients were concurrently treated with antiepileptic drugs (levetiracetam). The main reason for switching drugs (7/10) was the difficulty in achieving and maintaining an adequate time in therapeutic range while in VKA treatment; patients’ preferences were considered as well. During a period of DOACs’ treatment of 9±9 months (range 1-26 months), no CVT recurrences nor major/non-major clinically relevant bleedings were recorded.
Conclusions: CVT is often unprovoked and can require an extended anticoagulant treatment. While on VKA treatment, maintaining a therapeutic INR is sometimes challenging. According to our experience, DOACs seem to be a promising option for extended treatment in patients with CVT. Further investigations on this topic are needed.
To cite this abstract in AMA style:Barbar S, Boscaro F, De Bon E, Bozzolin A, Scarano L, Fabris F, Sartori MT. Cerebral Vein Thrombosis Treatment with Direct Oral Anticoagulants: A Case Series [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/cerebral-vein-thrombosis-treatment-with-direct-oral-anticoagulants-a-case-series/. Accessed January 23, 2022.
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