影响脑静脉窦和静脉血栓形成患者真实使用直接口服抗凝剂的因素。
Factors influencing real-life use of direct oral anticoagulants in patients with cerebral sinus and venous thrombosis.
机构信息
Department of Neurology, Ziv Medical Center, Safed, Israel; The Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Department of Neurology Tel Aviv Sourasky Medical Center, Israel.
出版信息
J Stroke Cerebrovasc Dis. 2023 Sep;32(9):107223. doi: 10.1016/j.jstrokecerebrovasdis.2023.107223. Epub 2023 Jul 10.
BACKGROUND
Direct oral anticoagulants (DOAC) are advocated as equally effective to vitamin K antagonists (VKA) for the treatment of patients with cerebral sinus and venous thrombosis (CSVT). However, data concerning the real-life management practices in CSVT patients are is lacking.
METHODS
Prospective CSVT databases from four large academic medical centers were retrospectively studied. Demographics, clinical presentations, risk factors, radiological and outcome parameters were compared between CSVT patients treated with DOAC and VKA.
RESULTS
Out of 504 CSVT patients, 43 (8.5%) were treated with DOAC, and the remaining 461 (91.5%) were treated with VKA. All patients with antiphospholipid syndrome (APLA) were treated with VKA (61 vs. 0, p=0.013). Patients with a history or presence of malignancy were also more often treated with VKA (16% vs. 5%, p=0.046). Other risk factors for thrombosis did not differ between the groups. There were no differences in clot extent or location and no differences in the percentage of favorable outcomes or mortality were observed.
CONCLUSION
Our data suggests that only malignancy and antiphospholipid antibodies significantly influenced physician's decisions towards choosing VKA rather than DOAC. DOAC appear to be as effective and safe as VKA in patients with CSVT.
背景
直接口服抗凝剂（DOAC）在治疗脑窦和静脉血栓形成（CSVT）患者方面被认为与维生素 K 拮抗剂（VKA）同样有效。然而，关于 CSVT 患者的实际管理实践的数据仍然缺乏。
方法
回顾性研究了来自四个大型学术医疗中心的前瞻性 CSVT 数据库。比较了接受 DOAC 和 VKA 治疗的 CSVT 患者的人口统计学、临床表现、危险因素、影像学和结局参数。
结果
504 例 CSVT 患者中，43 例（8.5%）接受 DOAC 治疗，其余 461 例（91.5%）接受 VKA 治疗。所有抗磷脂综合征（APLA）患者均接受 VKA 治疗（61 例 vs. 0 例，p=0.013）。有或有恶性肿瘤病史的患者也更常接受 VKA 治疗（16% vs. 5%，p=0.046）。其他血栓形成危险因素在两组之间无差异。血栓扩展程度或位置无差异，良好结局或死亡率也无差异。
结论
我们的数据表明，只有恶性肿瘤和抗磷脂抗体显著影响医生选择 VKA 而不是 DOAC 的决定。DOAC 在 CSVT 患者中的疗效和安全性与 VKA 相当。
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