Umurungi Johanna, Ferrando Francesca, Cilloni Daniela, Sivera Piera
Department of Clinical and Biological Sciences, University of Turin, 10043 Turin, Italy.
Department of Medical Sciences, University of Turin, 10126 Turin, Italy.
J Clin Med. 2024 Aug 12;13(16):4730. doi: 10.3390/jcm13164730.
Cerebral venous thrombosis (CVT) is a rare type of cerebrovascular event in which the thrombosis occurs in a vein of the cerebral venous system. The diagnosis could be challenging due to the great clinical variability, but the outcome is favourable in most cases, especially in the case of early diagnosis. Anticoagulant therapy is the core of CVT management and currently consists of heparin in the acute phase followed by vitamin K antagonists (VKAs) in the long term. The ideal duration of anticoagulant therapy is still unclear, and the same criteria for the treatment of extracerebral venous thromboembolism currently apply. In this paper, we reviewed the literature regarding the use of direct oral anticoagulants (DOACs) in CVT since in recent years a considerable number of studies have been published on the use of these drugs in this specific setting. DOACs have already been shown to be equally effective with VKAs in the treatment of venous thromboembolism. In addition to efficacy, DOACs appear to have the same safety profile, being, on the other hand, more manageable, as they do not require close monitoring with continuous personalised dose adjustments. In addition, a further advantage of DOACs over VKAs is the possibility of anticoagulant prophylaxis using a reduced dosage of the drug. In conclusion, although the use of DOACs appears from preliminary studies to be effective and safe in the treatment of CVT, additional studies are needed to include these drugs in the treatment of CVT.
脑静脉血栓形成（CVT）是一种罕见的脑血管事件，其血栓形成于脑静脉系统的静脉中。由于临床差异很大，诊断可能具有挑战性，但在大多数情况下，尤其是早期诊断时，预后良好。抗凝治疗是CVT管理的核心，目前在急性期使用肝素，长期使用维生素K拮抗剂（VKA）。抗凝治疗的理想持续时间仍不明确，目前适用于治疗脑外静脉血栓栓塞的相同标准。在本文中，我们回顾了关于直接口服抗凝剂（DOAC）在CVT中应用的文献，因为近年来已经发表了大量关于这些药物在这种特定情况下应用的研究。DOAC在治疗静脉血栓栓塞方面已被证明与VKA同样有效。除了疗效外，DOAC似乎具有相同的安全性，另一方面，由于它们不需要通过持续的个性化剂量调整进行密切监测，因此更易于管理。此外，DOAC相对于VKA的另一个优势是可以使用较低剂量的药物进行抗凝预防。总之，尽管从初步研究来看，DOAC在治疗CVT方面似乎有效且安全，但仍需要更多研究将这些药物纳入CVT的治疗中。
