Dubey Ashish K, Kalita Jayantee, Chaudhary Sarvesh K, Misra Usha K
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh 226014, India.
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Rae Bareli Road, Lucknow, Uttar Pradesh 226014, India.
J Clin Neurosci. 2021 Jul;89:43-50. doi: 10.1016/j.jocn.2021.04.016. Epub 2021 Apr 29.
Effective anticoagulation status may determine the recanalization and outcome of cerebral venous thrombosis (CVT). We report impact of anticoagulation status on recanalization and outcome of CVT. This is a retrospective study on 126 patients with CVT diagnosed on magnetic resonance venography (MRV). Their clinical features and risk factors were noted. The data were retrieved from a prospectively maintained registry, and international normalized ratio (INR) was noted after discharge till 3 months. All the patients were on acenocoumarol. Based on INR value, patients were categorized as Group A (effective anticoagulation INR within the therapeutic range or above) and Group B (ineffective anticoagulation INR > 50% below the therapeutic range). A repeat MRV at 3 months was done for recanalization. Outcome at 3 months was evaluated using modified Rankin Scale (mRS), and categorized as good (mRS ≤ 2) and poor (mRS 2 or more) 101(80.2%) patients were in group A and 25(19.8%) in group B. Their demographic, risk factors, magnetic resonance imaging (MRI) and MRV findings were comparable. On repeat MRV, recanalization occurred in 22/24(91.7%); 15(88%) in group A and 7(100%) in group B. Recanalization was independent of coagulation status. Seven (5.6%) patients died and 107(84.9%) had good outcome; 85(84.2%) in group A and 22(88%) in group B. Kaplan Meier analysis also did not reveal survival or good outcome benefits between the groups. In CVT, outcome and recanalization at 3 months are not dependent on coagulation status. Further prospective studies are needed regarding duration of anticoagulant and its impact on recanalization and outcome.
有效的抗凝状态可能决定脑静脉血栓形成（CVT）的再通情况和预后。我们报告了抗凝状态对CVT再通情况和预后的影响。这是一项对126例经磁共振静脉血管造影（MRV）诊断为CVT的患者进行的回顾性研究。记录了他们的临床特征和危险因素。数据来自一个前瞻性维护的登记处，并记录出院后至3个月的国际标准化比值（INR）。所有患者均服用醋硝香豆素。根据INR值，将患者分为A组（有效抗凝，INR在治疗范围内或以上）和B组（无效抗凝，INR低于治疗范围的50%）。3个月时进行重复MRV以评估再通情况。使用改良Rankin量表（mRS）评估3个月时的预后，并分为良好（mRS≤2）和不良（mRS＞2）。A组有101例（80.2%）患者，B组有25例（19.8%）患者。他们的人口统计学、危险因素、磁共振成像（MRI）和MRV结果具有可比性。重复MRV时，22/24例（91.7%）实现再通；A组15例（88%），B组7例（100%）。再通与凝血状态无关。7例（5.6%）患者死亡，107例（84.9%）预后良好；A组85例（84.2%），B组22例（88%）。Kaplan Meier分析也未显示两组之间在生存或良好预后方面存在差异。在CVT中，3个月时的预后和再通情况不依赖于凝血状态。关于抗凝剂的持续时间及其对再通情况和预后的影响，还需要进一步的前瞻性研究。
