Abstract Number: PB2414
Meeting: ISTH 2020 Congress
Theme: Venous Thromboembolism and Cardioembolism » VTE Treatment
Background: Cerebral vein thrombosis (CVT) typically affects young adults and requires anticoagulation for a period that varies from 3 months to lifelong. Direct oral anticoagulants (DOAC), because of their safety profile and the lack of laboratory monitoring, may represent a valid alternative to vitamin K antagonists (VKA). To date, one phase III trial evaluated dabigatran compared to VKA, while the use of the anti-Xa have been described in case reports and series only.
Aims: To evaluate the efficacy and safety of DOAC in patients with CVST compared to VKA.
Methods: All consecutive patients with CVT from September 2013 to January 2019 were included in the study. Recurrent or progressive thrombosis and bleeding complications were the study outcomes, expressed in terms of cumulative incidence rates.
Results: Eighty-two patients with CVT were included, 17 treated with DOAC (all anti-Xa) and 65 with VKA. In both groups the median age at diagnosis was 40 years and male to female ratio 1:3. One patient treated with apixaban had a CVT progression and one on VKA had a superficial thrombophlebitis. Bleeding occurred in 5 patients (17%) treated with DOAC (all on apixaban or rivaroxaban) (1 severe and 3 mild menorrhagia and 1 subdural hematoma) and in 3 (5%) with VKA (1 severe and 2 mild menorrhagia). A time-to-event analysis was performed showing a cumulative incidence rate of bleeding and thrombotic episodes from start of anticoagulation until 12 months of treatment of 2% and 2% respectively in the VKA group and 31% and 9% respectively in the DOAC group.
Conclusions: Considering the limitation of the sample size, our results raise some concerns on efficacy and safety of anticoagulant treatment with anti-Xa DOAC in patients with CVST. Further data from randomized controlled trial are needed.
[Figure 1. Kaplan-Meier estimates for thrombotic events (upper panel) and bleeding events (lower panel) in CVT patients treated with DOAC or VKA.]
To cite this abstract in AMA style:
Capecchi M, Abbattista M, Gianniello F, Artoni A, Bucciarelli P, Peyvandi F, Martinelli I. Direct Oral Anticoagulants and Vitamin K Antagonists for Treatment of Cerebral Vein Thrombosis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/direct-oral-anticoagulants-and-vitamin-k-antagonists-for-treatment-of-cerebral-vein-thrombosis/. Accessed March 21, 2024.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/direct-oral-anticoagulants-and-vitamin-k-antagonists-for-treatment-of-cerebral-vein-thrombosis/