Phan Paul, Hong Lisa T
Pharmacy Department, Loma Linda University Health, Loma Linda, CA, USA.
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA.
Clin Appl Thromb Hemost. 2025 Jan-Dec;31:10760296251316869. doi: 10.1177/10760296251316869.
Limited available evidence comparing DOACs with warfarin suggests efficacy and safety of DOACs for CVT. We aimed to evaluate whether a specific DOAC is preferred for the treatment of CVT. This retrospective cohort study included adult patients with CVTs between September 2018 and September 2022 treated with a DOAC. The primary outcome was rate of partial or complete recanalization. Secondary outcomes included rate of recurrent VTE, CVT extension, major or clinically relevant non-major bleeding, and death within 180 days after DOAC initiation. Of 31 patients with CVT, 21 received apixaban, 7 received rivaroxaban, and 3 received dabigatran. Among those with repeat imaging, the primary composite outcome occurred in 100%, 80%, and 100% for each group, respectively (P = 0.34). One patient had extension of CVT while on apixaban and one patient had increased midline shift while on rivaroxaban. No other secondary outcomes were observed. There do not appear to be significant efficacy or safety differences between DOACs when used for CVT treatment, though larger studies are needed to validate these findings.
比较直接口服抗凝剂（DOACs）与华法林的现有证据有限，提示DOACs用于治疗脑静脉窦血栓形成（CVT）的有效性和安全性。我们旨在评估治疗CVT时是否更倾向于使用某种特定的DOAC。这项回顾性队列研究纳入了2018年9月至2022年9月期间接受DOAC治疗的成年CVT患者。主要结局是部分或完全再通率。次要结局包括复发性静脉血栓栓塞（VTE）率、CVT扩展、严重或临床相关的非严重出血以及开始使用DOAC后180天内的死亡率。在31例CVT患者中，21例接受阿哌沙班治疗，7例接受利伐沙班治疗，3例接受达比加群治疗。在接受重复影像学检查的患者中，每组主要复合结局的发生率分别为100%、80%和100%（P = 0.34）。1例患者在服用阿哌沙班时出现CVT扩展，1例患者在服用利伐沙班时中线移位增加。未观察到其他次要结局。DOACs用于CVT治疗时，在有效性或安全性方面似乎没有显著差异，不过需要更大规模的研究来验证这些发现。
