Bajko Zoltan, Maier Smaranda, Motataianu Anca, Filep Rares Cristian, Stoian Adina, Andone Sebastian, Balasa Rodica
Department of Neurology, University of Medicine, Pharmacy, Science and Technology Targu Mures, Targu-Mures, Romania.
Department of Interventional Radiology, Mures County Clinical Emergency Hospital, Targu-Mures, Romania.
Acta Neurol Belg. 2022 Feb;122(1):105-111. doi: 10.1007/s13760-021-01651-z. Epub 2021 Mar 18.
The mainstay of cerebral venous thrombosis (CVT) treatment according to current guidelines is parenteral anticoagulation with unfractionated heparin or low-molecular-weight heparin followed by long-term oral anticoagulation with vitamin K antagonists. Direct oral anticoagulants (DOACs), including the factor Xa inhibitor rivaroxaban, are used occasionally off-label for CVT based on individual treatment plans. This publication sought to report our experience with rivaroxaban for the indication of CVT and to review the relevant literature data concerning this topic. We performed a single-center retrospective analysis including patients from our institution with the diagnosis of cerebral venous thrombosis treated with rivaroxaban. Among 12,500 stroke patients over an 11-year period, we identified 87 cases with a diagnosis of CVT (0.7%). As long-term anticoagulation, 80 of these patients were receiving vitamin K antagonists and seven were receiving DOACs, including six receiving rivaroxaban and one receiving apixaban. Of the six patients receiving rivaroxaban, at least 6 months of clinical follow-up data were available for five of them. Excellent clinical outcomes were obtained in four of these five cases (modified Rankin scale score: 0-1 points). No hemorrhagic events, recurrent thrombosis, or other relevant complications were recorded during the follow-up period. Despite our small study sample size, our positive results support that rivaroxaban may be a safe and effective treatment option for patients with CVT. Hopefully, ongoing randomized clinical trials will better clarify the role of rivaroxaban in the treatment of CVT so as to provide a more convenient and safer alternative to vitamin K antagonists in this context.
根据当前指南，脑静脉血栓形成（CVT）治疗的主要方法是使用普通肝素或低分子肝素进行胃肠外抗凝，随后使用维生素K拮抗剂进行长期口服抗凝。直接口服抗凝剂（DOACs），包括Xa因子抑制剂利伐沙班，根据个体治疗方案偶尔用于CVT的非标签治疗。本出版物旨在报告我们使用利伐沙班治疗CVT的经验，并回顾有关该主题的相关文献数据。我们进行了一项单中心回顾性分析，纳入了我院诊断为脑静脉血栓形成并接受利伐沙班治疗的患者。在11年期间的12500例卒中患者中，我们确定了87例CVT诊断病例（0.7%）。作为长期抗凝治疗，这些患者中有80例接受维生素K拮抗剂治疗，7例接受DOACs治疗，其中6例接受利伐沙班治疗，1例接受阿哌沙班治疗。在接受利伐沙班治疗的6例患者中，有5例至少有6个月的临床随访数据。这5例患者中有4例获得了良好的临床结果（改良Rankin量表评分：0 - 1分）。随访期间未记录出血事件、复发性血栓形成或其他相关并发症。尽管我们的研究样本量较小，但我们的阳性结果支持利伐沙班可能是CVT患者的一种安全有效的治疗选择。希望正在进行的随机临床试验将更好地阐明利伐沙班在CVT治疗中的作用，以便在这种情况下为维生素K拮抗剂提供更方便、更安全的替代方案。
