Vojjala Nikhil, Peshin Supriya, Kattamuri Lakshmi Prasanna Vaishnavi, Iqbal Rabia, Dharia Adit, Jayakumar Jayalekshmi, Iftekhar Rafi, Singh Shagun, Balla Mamtha, Villa Celi Claudia S, Ramachandran Ramya, Prabhu Rishab, Yadav Sumeet K, Krishnamoorthy Geetha, Singh Vijendra, Seegobin Karan
Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USA.
Department of Internal Medicine, Norton Community Hospital, Norton, VA 24273, USA.
Biomedicines. 2025 Jan 14;13(1):189. doi: 10.3390/biomedicines13010189.
Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, constituting 0.5-3% of all strokes with an extremely varied spectrum of presentation, predisposing factors, neuroimaging findings, and eventual outcomes. A high index of suspicion is needed because timely diagnosis can significantly alter the natural course of the disease, reduce acute complications, and improve long-term outcomes. Due to its myriad causative factors, protean presentation, and association with several systemic diseases, CVT is encountered not only by neurologists but also by emergency care practitioners, internists, hematologists, obstetricians, and pediatricians.
Anticoagulation remains the mainstay of treatment for CVT. Heparin and warfarin previously had been the anticoagulation of choice. Recently there has been an increased interest in utilizing direct-acting oral anticoagulants in the treatment of CVT given comparable safety and efficacy with ease of utilization. However recent clinical guidelines given by multiple societies including the American Stroke guidelines and European guidelines do not include these agents so far in their treatment recommendations. Ongoing multicentric clinical trials are currently reviewing the role of these agents in both short-term as well as long-term. Our review of the literature supports the safety and reinforces the efficacy of DOAC in the treatment of CVT. Additionally, patient satisfaction has been shown to be better with the use of DOAC. In conclusion, DOAC continues to have a valid role in the management of CVT.
脑静脉窦血栓形成（CVT）是一种罕见的中风病因，占所有中风的0.5%-3%，其临床表现、诱发因素、神经影像学表现及最终结局极为多样。由于及时诊断可显著改变疾病的自然病程、减少急性并发症并改善长期预后，因此需要高度怀疑。由于其病因众多、表现多变且与多种全身性疾病相关，不仅神经科医生，急诊科医生、内科医生、血液科医生、产科医生和儿科医生也会遇到CVT。
抗凝治疗仍然是CVT的主要治疗方法。肝素和华法林以前一直是抗凝治疗的首选药物。最近，由于直接作用口服抗凝剂具有相当的安全性和疗效且使用方便，人们对其在CVT治疗中的应用兴趣有所增加。然而，包括美国中风指南和欧洲指南在内的多个学会发布的最新临床指南目前在其治疗建议中并未纳入这些药物。正在进行的多中心临床试验目前正在评估这些药物在短期和长期治疗中的作用。我们对文献的综述支持了直接作用口服抗凝剂在CVT治疗中的安全性，并强化了其疗效。此外，使用直接作用口服抗凝剂的患者满意度更高。总之，直接作用口服抗凝剂在CVT的管理中继续发挥着有效的作用。
