Menon Deepak, Gupta Manisha, Ananthasubramanian Sangeeth Thuppanattumadam, Kulanthaivelu Karthik, Raja Pritam, Ramakrishnan Subasree, Karnam Sangeetha Seshagiri, Saini Jitender, Srijithesh P R, Kulkarni Girish B
Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
Ann Indian Acad Neurol. 2024 Nov 1;27(6):657-662. doi: 10.4103/aian.aian_359_24. Epub 2024 Nov 25.
Early initiation and maintenance of anticoagulation appears to be the mainstay of treatment of cerebral venous thrombosis (CVT), but the evidence supporting the intensity and duration of anticoagulation is limited.
We retrospectively collected data of patients admitted with CVT over a 5-year period, who had a minimum of 6 months of clinical follow-up and three or more prothrombin time international normalized ratio (INR) values spread over 6 months. Data collected included demographic, clinical, and radiologic parameters, anticoagulation status during the follow-up, complications, and clinical status at the last follow-up.
We identified 204 patients, and the mean age was 34.4 ± 11.1 years. The majority had a provoked etiology (194, 95.1%) for CVT. After initial anticoagulation with unfractionated heparin, all patients transitioned to acenocoumarol or warfarin and this was maintained for a mean duration of 16.02 ± 11.2 months. Time in therapeutic range of INR 2-3 was only 5.1 ± 11.8 percent days and time spent in an INR of 1-1.5 was 68.7 ± 31.8 percent days. The average INR over 6 months was 1.37 ± 0.33. Duration of follow-up was 18.9 ± 13.25 months, and a good outcome was noted in 183 (89.7%) patients. Complications were seen in 29 (14.2%) patients. Multivariate analysis showed only the CVT grading scale score to be an independent predictor of good outcome.
Maintenance of an intensive level of anticoagulation may not be required in patients with CVT and may be particularly true when a transient and treatable risk factor is the provoking etiology.
早期启动并维持抗凝治疗似乎是脑静脉窦血栓形成（CVT）治疗的主要手段，但支持抗凝强度和持续时间的证据有限。
我们回顾性收集了5年内因CVT入院患者的数据，这些患者至少有6个月的临床随访且在6个月内有3个或更多的凝血酶原时间国际标准化比值（INR）值。收集的数据包括人口统计学、临床和放射学参数、随访期间的抗凝状态、并发症以及最后一次随访时的临床状态。
我们确定了204例患者，平均年龄为34.4±11.1岁。大多数患者CVT的病因是诱发性的（194例，95.1%）。在用普通肝素进行初始抗凝后，所有患者均转换为醋硝香豆素或华法林，并维持平均16.02±11.2个月。INR在2 - 3治疗范围内的时间仅为5.1±11.8%天，INR在1 - 1.5的时间为68.7±31.8%天。6个月内的平均INR为1.37±0.33。随访时间为18.9±13.25个月，183例（89.7%）患者预后良好。29例（14.2%）患者出现并发症。多因素分析显示只有CVT分级量表评分是预后良好的独立预测因素。
CVT患者可能不需要维持高强度的抗凝治疗，当诱发性病因是短暂且可治疗的危险因素时尤其如此。
