Department of Neurology, Jagiellonian University Medical College, 3 Botaniczna St., Kraków, Poland.
John Paul II Hospital, 80 Prądnicka St, Kraków, Poland.
Neurol Neurochir Pol. 2019;53(5):384-387. doi: 10.5603/PJNNS.a2019.0037. Epub 2019 Aug 27.
Oral anticoagulants, preferentially vitamin K antagonists (VKA), are recommended for 3-12 months in patients with cerebral venous sinus thrombosis (CVST). We present a series of patients with CVST treated with direct oral anticoagulants (DOAC).
We prospectively recruited 36 patients with CVST (aged 40.3 ± 9.2 years, 58.3% female) treated with DOAC based on the physician's or patient's preferences. Functional outcome was assessed with modified Rankin Scale. Recanalisation was assessed on imaging at 3-6 months post the event. Patients were followed for a median of 30 [interquartile range (IQR) 25-37] months.
After use of heparin (median: 6 days; IQR 5-8.75), patients received dabigatran (150 mg bid, n = 16 or 110 mg bid, n = 2), rivaroxaban (20 mg qd, n = 10) or apixaban (5 mg bid, n = 8) for a median of 8.5 months (IQR 6.25-12). Complete or partial recanalisation was observed in 34 cases (94.4%). Three patients (8.3%) experienced major bleeding: menorrhagia on rivaroxaban (n = 2) and gastrointestinal bleeding on dabigatran (n = 1). A favourable functional outcome was observed in 24 (66.7%) patients, without any fatality. CSVT recurred in two patients (5.6%) and two venous thromboses developed in two other patients with inherited thrombophilia after anticoagulation withdrawal.
DOACs could be an alternative to VKA in CVST patients.
脑静脉窦血栓形成（CVST）患者推荐使用口服抗凝剂，优选维生素 K 拮抗剂（VKA），治疗 3-12 个月。我们报告了一系列使用直接口服抗凝剂（DOAC）治疗的 CVST 患者。
我们前瞻性招募了 36 名 CVST 患者（年龄 40.3±9.2 岁，58.3%为女性），根据医生或患者的偏好，使用 DOAC 进行治疗。使用改良 Rankin 量表评估功能结局。在发病后 3-6 个月进行影像学评估再通情况。患者中位随访时间为 30 个月[四分位距（IQR）25-37]。
在使用肝素（中位数：6 天；IQR 5-8.75）后，患者接受达比加群（150mg，bid，n=16 或 110mg，bid，n=2）、利伐沙班（20mg，qd，n=10）或阿哌沙班（5mg，bid，n=8）治疗，中位数为 8.5 个月（IQR 6.25-12）。34 例（94.4%）患者观察到完全或部分再通。3 例（8.3%）患者发生大出血：利伐沙班（n=2）出现月经过多，达比加群（n=1）出现胃肠道出血。24 例（66.7%）患者功能结局良好，无死亡病例。2 例（5.6%）患者 CVST 复发，2 例遗传性血栓形成倾向患者在抗凝治疗停药后发生其他静脉血栓形成。
DOAC 可能是 CVST 患者的 VKA 替代方案。
