Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, Saudi Arabia.
Corresponding author: Rizwana Shahid, MBBS, FCPS, Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, 31952, Saudi Arabia (
Prim Care Companion CNS Disord. 2021 Nov 24;23(6):21m02927. doi: 10.4088/PCC.21m02927.
To compare the safety and efficacy of conventional anticoagulants with new oral anticoagulants (NOACs) for management of cerebral venous sinus thrombosis (CVST). This was a retrospective, prospective cohort study of patients who presented with CVST to a tertiary stroke center in the Middle East from January 2012 to October 2019. Patients with a diagnosis of CVST were identified, and data were analyzed for demographic characteristics. Specific consideration was given to compare the efficacy and safety of different anticoagulation treatments. A total of 36 patients were included in the final analysis, with 15 (41%) men and 21 (59%) women and a male to female ratio of 1:1.4. Most of the patients (n = 22, 61%) were Saudi. Their ages ranged between 15 and 82 years (mean ± SD age of 34.22 ± 13.16 years). Headache was the most common feature, present in 22 (61%) of the patients, followed by unilateral weakness in 15 (41%) and cranial nerve palsies in 11 (30%). The most common etiology was prothrombotic state (both hereditary and acquired thrombophilia: n = 16, 45%). Other etiologies were postpartum state/oral contraceptive pill usage in 7 (19%), infections in 7 (19%), and trauma in 3 (8%). Most of the patients (n = 24, 67%) still received conventional anticoagulation (warfarin/low molecular weight heparin), but 9 (25%) of the patients consented to start NOACs. Efficacy (as measured by clinical improvement plus rate of recanalization of previously thrombosed venous sinuses) showed no statistically significant difference, although it proved to be better tolerated, as none of the patients stopped the treatment due to adverse events and risk of major bleeding was significantly low in the NOAC group. Nine patients in the warfarin group stopped medication, while none in the NOAC group did so ( = .034). NOACs were found to be at least as good as conventional anticoagulation for the management of CVST. However, efficacy was almost similar, a finding that is consistent with most of the published case series and the few recently published prospective studies. Larger prospective and population-based studies are needed to clarify our preliminary results.
比较新型口服抗凝剂（NOACs）与传统抗凝剂在治疗脑静脉窦血栓形成（CVST）中的安全性和疗效。这是一项回顾性、前瞻性队列研究，纳入了 2012 年 1 月至 2019 年 10 月期间在中东一家三级卒中中心就诊的 CVST 患者。对患者的人口统计学特征进行了分析，特别考虑了不同抗凝治疗的疗效和安全性。最终有 36 例患者纳入最终分析，其中 15 例（41%）为男性，21 例（59%）为女性，男女比例为 1:1.4。大多数患者（n=22，61%）为沙特人。年龄在 15-82 岁之间（平均年龄 34.22±13.16 岁）。头痛是最常见的特征，22 例（61%）患者有头痛，15 例（41%）患者有单侧无力，11 例（30%）患者有颅神经麻痹。最常见的病因是血栓形成前状态（遗传性和获得性血栓形成倾向：n=16，45%）。其他病因包括产后状态/口服避孕药使用 7 例（19%）、感染 7 例（19%）和创伤 3 例（8%）。大多数患者（n=24，67%）仍接受传统抗凝治疗（华法林/低分子肝素），但 9 例（25%）患者同意开始使用 NOACs。虽然疗效（以临床改善和先前血栓形成的静脉窦再通率来衡量）无统计学差异，但 NOACs 的耐受性更好，因为没有患者因不良事件而停止治疗，而且大出血的风险在 NOAC 组显著较低。华法林组有 9 例患者停止用药，而 NOAC 组无此情况（ = .034）。NOACs 至少与传统抗凝剂一样适用于 CVST 的治疗。然而，疗效几乎相似，这一发现与大多数已发表的病例系列和少数最近发表的前瞻性研究一致。需要更大规模的前瞻性和基于人群的研究来澄清我们的初步结果。
