Al Kasab Sami, Almallouhi Eyad, Shu Liqi, Kicielinski Kimberly P, Salehi Omran Setareh, Liebeskind David S, Zubair Adeel S, Vedovati Maria C, Paciaroni Maurizio, Antonenko Kateryna, Heldner Mirjam R, de Havenon Adam, Henninger Nils, Yaghi Shadi
Department of Neurology (SAK, EA); Department of Neurosurgery (SAK, EA, KPK), Medical University of South Carolina, Charleston, SC; Department of Neurology (LS, SY), Brown University, Providence, RI; Department of Neurology (SSO), University of Colorado School of Medicine, Aurora; Department of Neurology (DSL), University of California at Los Angeles; Department of Neurology (ASZ, AH), Yale University, New Haven, CT; Department of Medicine and Surgery (MCV, MP), University of Perugia, Italy; Department of Neurology (KA, MRH), University Hospital and University of Bern, Switzerland; Department of Neurology (NH), and Department of Psychiatry (NH), University of Massachusetts, Worcester, MA.
Neurol Clin Pract. 2025 Feb;15(1):e200381. doi: 10.1212/CPJ.0000000000200381. Epub 2024 Oct 8.
Cerebral venous thrombosis (CVT) is a rare cause of stroke. While the standard treatment is anticoagulation, the type and duration of anticoagulation depends on the underlying etiology. This study aims to identify prevalence, risk factors, and recurrent venous thromboembolism (VTE) rates among patients with idiopathic (cryptogenic) CVT and CVT provoked by transient (peripartum, hormonal treatment, infection, trauma) and persistent (cancer, thrombophilia) factors.
We used the ACTION-CVT retrospective database which included consecutive patients who were treated for CVT in 27 stroke centers in the United States, Europe, and New Zealand from January 2015 to December 2020. We compared baseline characteristics and outcomes of patients with cryptogenic, transient provoked (TP) and those with persistent provoked (PP) CVT. Baseline characteristics was compared between the groups using χ test, test, or Mann-Whitney test as appropriate, followed by multivariable regression. We used Kaplan-Meier survival analysis to assess outcome occurrence. We used interaction analysis and Cox regression to assess the risks of recurrent VTE in patients with CVT.
Among 1,025 included participants with CVT, 510 (49.8%) had no identified risk factor (cryptogenic), 363 (35.4%) had at least one transient provoking factor, and 152 (14.8%) had a persistent provoking factor. Patients with TP CVT were younger ( = 0.003) and more likely to be female patients ( < 0.001). When compared with patients with TP CVT, the risk of recurrent VTE was greater in patients with PP CVT (HR 2.59, 95% CI 1.29-5.22, = 0.008) and nonsignificantly elevated in patients with cryptogenic CVT (HR 1.85. 95% CI 0.98-3.59, = 0.059). In the interaction analysis, there was a trend toward higher rate of recurrent VTE in female patients with cryptogenic CVT and male patients with PP CVT.
In this multicenter study, we found that outcomes of CVT differed depending on the underlying etiology. The risk of recurrent VTE in the PP and cryptogenic CVTs may be influenced by sex.
脑静脉血栓形成（CVT）是一种罕见的卒中病因。虽然标准治疗方法是抗凝，但抗凝的类型和持续时间取决于潜在病因。本研究旨在确定特发性（隐源性）CVT患者以及由短暂性（围产期、激素治疗、感染、创伤）和持续性（癌症、易栓症）因素引发的CVT患者的患病率、危险因素及复发性静脉血栓栓塞（VTE）发生率。
我们使用了ACTION - CVT回顾性数据库，该数据库纳入了2015年1月至2020年12月期间在美国、欧洲和新西兰的27个卒中中心接受CVT治疗的连续患者。我们比较了隐源性、短暂性引发（TP）和持续性引发（PP）CVT患者的基线特征和结局。使用χ²检验、t检验或Mann - Whitney U检验（视情况而定）在组间比较基线特征，随后进行多变量回归分析。我们使用Kaplan - Meier生存分析来评估结局的发生情况。我们使用交互分析和Cox回归来评估CVT患者复发性VTE的风险。
在1025例纳入的CVT参与者中，510例（49.8%）未发现危险因素（隐源性），363例（35.4%）有至少一个短暂性诱发因素，152例（14.8%）有持续性诱发因素。TP CVT患者更年轻（P = 0.003），且更可能为女性患者（P < 0.001）。与TP CVT患者相比，PP CVT患者复发性VTE的风险更高（HR 2.59，95%CI 1.29 - 5.22，P = 0.008），而隐源性CVT患者复发性VTE风险虽有升高但无统计学意义（HR 1.85，95%CI 0.98 - 3.59，P = 0.059）。在交互分析中，隐源性CVT女性患者和PP CVT男性患者的复发性VTE发生率有升高趋势。
在这项多中心研究中，我们发现CVT的结局因潜在病因不同而有所差异。PP和隐源性CVT中复发性VTE的风险可能受性别影响。
