Department of Pathology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta.
Br J Haematol. 2022 Jul;198(1):165-182. doi: 10.1111/bjh.18177. Epub 2022 Mar 31.
Vitamin K antagonists (VKAs) are the standard oral anti-coagulant treatment for patients with cerebral venous thrombosis (CVT). However, the direct oral anti-coagulants (DOACs) started replacing VKAs also in this setting. We aimed to evaluate safety and efficacy of the DOACs for CVT treatment. We performed a systematic review and meta-analysis (PROSPERO protocol registration number CRD42020191472). The electronic databases MEDLINE, EMBASE and CENTRAL were searched from inception to January 2022. We included randomised controlled trials (RCTs) and observational studies, enrolling at least 10 adult patients with CVT treated with any DOACs. Twenty-three studies were included, for a total of 618 CVT patients treated with DOACs (treatment duration range 3-12 months). Mortality rate was 1.76% [95% confidence interval (CI) 0.70%-3.24%; I = 0%; 5/428 patients, 18 studies]; major bleeding 2.41% (95% CI 1.26%-3.91%; I = 1.5%; 12/534 patients, 21 studies); recurrent thrombosis 2.05% (95% CI 1.04%-3.37%; I = 0%; 10/577 patients, 21 studies); excellent neurological outcome 85.9% (95% CI 79.0%-91.7%; I = 63.7%; 289/340 patients, 13 studies); vessel recanalisation 89.0% (95% CI 82.9%-93.9%; I = 62.7%; 316/359 patients, 16 studies). No significant differences emerged by study design (RCTs vs. observational studies) or by treatment (DOACs vs. VKAs). This systematic review showed that the DOACs might represent a reasonable oral anti-coagulant treatment option for CVT patients.
维生素 K 拮抗剂（VKAs）是治疗脑静脉血栓形成（CVT）患者的标准口服抗凝治疗药物。然而，直接口服抗凝剂（DOACs）也开始在这种情况下取代 VKAs。我们旨在评估 DOACs 治疗 CVT 的安全性和有效性。我们进行了系统评价和荟萃分析（PROSPERO 方案注册编号 CRD42020191472）。从成立到 2022 年 1 月，我们在 MEDLINE、EMBASE 和 CENTRAL 电子数据库中进行了检索。我们纳入了至少 10 名接受任何 DOACs 治疗的 CVT 成年患者的随机对照试验（RCT）和观察性研究。共纳入 23 项研究，总计纳入 618 例接受 DOACs 治疗的 CVT 患者（治疗持续时间 3-12 个月）。死亡率为 1.76%（95%置信区间[CI] 0.70%-3.24%；I 2=0%；5/428 例，18 项研究）；主要出血率为 2.41%（95%CI 1.26%-3.91%；I 2=1.5%；12/534 例，21 项研究）；复发性血栓形成率为 2.05%（95%CI 1.04%-3.37%；I 2=0%；10/577 例，21 项研究）；神经功能良好的结局率为 85.9%（95%CI 79.0%-91.7%；I 2=63.7%；289/340 例，13 项研究）；血管再通率为 89.0%（95%CI 82.9%-93.9%；I 2=62.7%；316/359 例，16 项研究）。研究设计（RCT 与观察性研究）或治疗方法（DOACs 与 VKAs）均未出现显著差异。本系统评价表明，DOACs 可能是 CVT 患者合理的口服抗凝治疗选择。
