Fayyaz Muniba, Abbas Fakhar, Kashif Tooba
Internal Medicine, Fatima Memorial Hospital, Lahore, PAK.
Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA.
Cureus. 2019 May 2;11(5):e4589. doi: 10.7759/cureus.4589.
Cerebral venous thrombosis (CVT) is a rare complication of hypercoagulable states such as pregnancy, lupus anticoagulant syndrome, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, malignancies, and the use of oral contraceptive pills. It most commonly occurs in young people, especially women, but can occur in the elderly as well. The signs and symptoms vary from focal neurological deficiencies to alteration in mental status. In this review, we compare the efficacy and safety profile of traditional anticoagulants heparin and vitamin K antagonists (warfarin) to novel oral anticoagulants, which include rivaroxaban, apixaban, dabigatran. The advantages of the new anticoagulants are their effectiveness, short half-life, oral intake instead of parenteral, and the decreased need for constantly monitoring prothrombin time (PT), activated partial thromboplastin time (APTT), and the international normalized ratio (INR). In this review, we discuss studies that demonstrate that these novel oral anticoagulants are effective and safe in treating cerebral venous thrombosis without many adverse effects when compared with traditional treatment options. There are also some case reports that point towards the effectiveness of newer agents; however, we need more studies with bigger samples to reach a conclusion in favor of new oral anticoagulants. The studies that have already been conducted can become the basis for conducting newer studies that can revolutionize the modern treatment for conditions like CVT.
脑静脉血栓形成(CVT)是高凝状态的一种罕见并发症,如妊娠、狼疮抗凝物综合征、系统性红斑狼疮、克罗恩病、溃疡性结肠炎、恶性肿瘤以及口服避孕药的使用。它最常发生于年轻人,尤其是女性,但老年人也可能发生。其体征和症状从局灶性神经功能缺损到精神状态改变不等。在本综述中,我们将传统抗凝剂肝素和维生素K拮抗剂(华法林)与新型口服抗凝剂(包括利伐沙班、阿哌沙班、达比加群)的疗效和安全性进行比较。新型抗凝剂的优点在于其有效性、半衰期短、口服而非胃肠外给药,以及减少了持续监测凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)和国际标准化比值(INR)的需求。在本综述中,我们讨论了一些研究,这些研究表明,与传统治疗方案相比,这些新型口服抗凝剂在治疗脑静脉血栓形成方面有效且安全,不良反应较少。也有一些病例报告指出了新型药物的有效性;然而,我们需要更多更大样本量的研究才能得出支持新型口服抗凝剂的结论。已经开展的研究可以成为开展更新研究的基础,这些更新研究可能会彻底改变CVT等疾病的现代治疗方法。