Mendonça Marcelo D, Barbosa Raquel, Cruz-e-Silva Vera, Calado Sofia, Viana-Baptista Miguel
Neurology Department, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
CEDOC, Nova Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisboa, Portugal.
Int J Stroke. 2015 Oct;10(7):1115-8. doi: 10.1111/ijs.12462. Epub 2015 Feb 24.
Cerebral vein thrombosis is a rare cause of stroke with significant risk of death and long-term dependency. Anticoagulation has been associated with better long-term prognosis, and vitamin K antagonists are usually prescribed in this setting.
The aim of this study was to present a series of 15 cerebral vein thrombosis patients treated with dabigatran.
Retrospective study of clinical, imaging, and follow-up characterization of all patients admitted with cerebral vein thrombosis and treated with dabigatran in a tertiary neurology department between June 2011 and December 2013 was conducted. Complications and adverse effects were recorded. Modified Rankin Scale was used to assess clinical severity; excellent outcome was defined as modified Rankin Scale at six-months of 0 to 1. Recanalization was assessed with an angiographic method (computer tomography, magnetic resonance imaging, or digital subtraction angiography).
Eighteen patients were admitted for cerebral vein thrombosis. Dabigatran was started in 11 patients, and warfarin was started in 7. Four patients on warfarin were switched to dabigatran because of adverse effects at 0·5, 1, 3·5, and 4 months. A total of 15 patients were treated with dabigatran with median follow-up time of 19 months. Excellent outcome was observed in 87% of patients and recanalization in 80%.
We report the largest series of cerebral vein thrombosis patients treated with dabigatran. Clinical outcome was excellent in most patients and not different from other studies. Dabigatran could possibly be considered an alternative to warfarin; nevertheless, further prospective assessment with randomized controlled studies is warranted.
脑静脉血栓形成是一种罕见的卒中病因，具有显著的死亡风险和长期依赖风险。抗凝治疗与更好的长期预后相关，在这种情况下通常会开具维生素K拮抗剂。
本研究的目的是介绍一系列15例接受达比加群治疗的脑静脉血栓形成患者。
对2011年6月至2013年12月在一家三级神经科收治的所有脑静脉血栓形成患者并接受达比加群治疗的患者进行临床、影像学和随访特征的回顾性研究。记录并发症和不良反应。使用改良Rankin量表评估临床严重程度；良好结局定义为6个月时改良Rankin量表评分为0至1。采用血管造影方法（计算机断层扫描、磁共振成像或数字减影血管造影）评估再通情况。
18例患者因脑静脉血栓形成入院。11例患者开始使用达比加群，7例患者开始使用华法林。4例使用华法林的患者因0.5、1、3.5和4个月时出现不良反应而改用达比加群。共有15例患者接受达比加群治疗，中位随访时间为19个月。87%的患者观察到良好结局，80%的患者实现再通。
我们报告了接受达比加群治疗的最大系列脑静脉血栓形成患者。大多数患者的临床结局良好，与其他研究无差异。达比加群可能被视为华法林的替代药物；然而，有必要通过随机对照研究进行进一步的前瞻性评估。
