Centro Integral de Neurología Vascular, FLENI. Ciudad Autónoma de Buenos Aires, Argentina; Hospital General de Agudos J. M. Ramos Mejía. Ciudad Autónoma Buenos Aires, Argentina.
Clínica La Sagrada Familia. Ciudad Autónoma de Buenos Aires, Argentina.
J Stroke Cerebrovasc Dis. 2020 Oct;29(10):105145. doi: 10.1016/j.jstrokecerebrovasdis.2020.105145. Epub 2020 Jul 28.
Cerebral venous thrombosis (CVT) is a rare medical condition that primarily affects young adults. The clinical spectrum is broad and its recognition remains a challenge for clinicians. Limited information is available on CVT in Argentina. Our goal was to report the results of the first National registry on CVT in Argentina and to compare clinical presentation, predisposing factors and outcomes with other international registries.
The Argentinian National Registry on CVT (ANR-CVT) is a multicenter retrospective cohort study comprising patients aged 18 and older with a diagnosis of CVT from January 2015 to January 2019. We evaluated demographics, predisposing factors, clinical presentation, and radiological characteristics (e.g. number of involved sinuses, venous infarction or hemorrhage on CT and MRI scans at admission), therapeutic interventions and functional outcomes at discharge and at 90 days. Our results were compared to a literature review of CVT registries.
Overall, one hundred and sixty-two patients met the inclusion criteria. The mean age was 42 (±17) years; 72% were women. Seventy percent of patients were younger than 50 years. The most common presenting symptom was headache (82%). The transverse sinus was the most common site of thrombosis (70%) followed by the sigmoid sinus (46%). The main predisposing factor in women was contraceptive use (44%), 3% of the events occurred during pregnancy and 9% during the puerperium. Participants 50 years and older had a higher frequency on malignancy related (7.5% vs. 30%, p = 0.0001) and infections (2% vs. 11%, p = 0.001). The modified Rankin Scale (mRS) ≤2 at discharge was 81% and the rate of mortality at discharge was 4%. At 90 days, the mRS≤2 was 93%. When the ANR-CVT was compared with larger registries from Europe and Asia, the prevalence of cancer among patients with CVT was two to five-fold higher (15% vs. 7% and 3%, respectively; p = 0.002 and p < 0.001). Anticoagulation rates at discharge were also higher (94%) compared to registries from Asia (ASCVT - 68%) or Turkey (VENOST - 67%).
Participants in the first ANR-CVT had a low mortality and disability at 90 days. Clinical and radiological characteristics were similar to CVT from other international registries with a higher prevalence of cancer. There was a high variability in treatment adherence to guidelines as reflected by anticoagulation rates (range 54.5%-100%) at discharge.
脑静脉血栓形成（CVT）是一种罕见的医学病症，主要影响年轻人。其临床表现广泛，对临床医生来说仍然是一个挑战。阿根廷的 CVT 相关信息有限。我们的目标是报告阿根廷首个 CVT 国家登记处的结果，并将临床表现、易患因素和结果与其他国际登记处进行比较。
阿根廷国家 CVT 登记处（ANR-CVT）是一项多中心回顾性队列研究，纳入了 2015 年 1 月至 2019 年 1 月期间诊断为 CVT 的年龄在 18 岁及以上的患者。我们评估了人口统计学、易患因素、临床表现和放射学特征（例如入院时 CT 和 MRI 扫描上受累窦数量、静脉梗死或出血）、治疗干预措施和出院时及 90 天时的功能结局。我们的结果与 CVT 登记处的文献复习进行了比较。
总体而言，有 162 名患者符合纳入标准。平均年龄为 42（±17）岁；72%为女性。70%的患者年龄小于 50 岁。最常见的首发症状是头痛（82%）。血栓形成最常见的部位是横窦（70%），其次是乙状窦（46%）。女性最常见的易患因素是使用避孕药（44%），3%的事件发生在怀孕期间，9%发生在产褥期。50 岁及以上的患者恶性肿瘤相关（7.5%比 30%，p=0.0001）和感染（2%比 11%，p=0.001）的频率更高。出院时改良 Rankin 量表（mRS）≤2 的比例为 81%，出院时死亡率为 4%。90 天时，mRS≤2 的比例为 93%。当 ANR-CVT 与来自欧洲和亚洲的更大登记处进行比较时，CVT 患者中癌症的患病率是两者的两到五倍（15%比 7%和 3%，分别为 p=0.002 和 p<0.001）。出院时的抗凝率也较高（94%），与来自亚洲的登记处（ASCVT-68%）或土耳其的登记处（VENOST-67%）相比。
首个 ANR-CVT 的参与者在 90 天时的死亡率和残疾率较低。临床和放射学特征与来自其他国际登记处的 CVT 相似，癌症患病率更高。出院时的抗凝治疗依从性存在很大差异，反映在抗凝率（范围 54.5%-100%）方面。
