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Lee GKH, Chen VH, Tan CH, Leow AST, Kong WY, Sia CH, Chew NWS, Tu TM, Chan BPL, Yeo LLL, Sharma VK, Tan BYQ. Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis. J Thromb Thrombolysis 2021; 50:724-731. [PMID: 32279216 DOI: 10.1007/s11239-020-02106-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cerebral venous thrombosis (CVT) causes significant disability and mortality. Current guidelines for CVT management support the initial use of unfractionated heparin or low molecular weight heparin followed by longer-term oral vitamin K antagonist (VKA). There has been increasing, albeit limited, evidence for the use of direct oral anticoagulants (DOAC) as an alternative to VKA. We performed a systematic review and meta-analysis of studies that compared the safety and efficacy of DOACs to VKA in treating CVT. A comprehensive literature search was carried out in Medline, Embase and Cochrane Stroke Group Trials Register using a suitable keyword/MeSH term search strategy. All studies published in English comparing outcomes of patients with CVT treated with DOAC or VKA were included. In total, 6 studies (5 observational studies and 1 randomized clinical trial) comprising 412 patients (age range 16-83 years) were analyzed. DOAC was used in 151 patients, while 261 received VKA. The follow-up period was 3-11 months. The efficacy of DOACs was comparable with VKA in terms of partial or full thrombus recanalization (RR 1.02, 95% CI 0.89-1.16) and excellent functional recovery with modified Rankin scale < 2 (RR 1.02, 95% CI 0.93-1.13). Patients treated with DOAC developed lower major bleeding events when compared to VKA, although this did not reach statistical significance (RR 0.44, 95% CI 0.12-1.59). We provide preliminary evidence to support DOAC as effective and safe alternatives to VKA in CVT treatment. We await the results of upcoming randomized trials to further support our results and validate the use of DOAC.
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Affiliation(s)
- Grace K H Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore
| | - Vanessa H Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore
| | - Choon-Han Tan
- Department of Medicine, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Aloysius S T Leow
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore
| | - Wan-Yee Kong
- Department of Neurology, Detroit Medical Centre, Detroit, MI, USA
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Nicholas W S Chew
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore
| | - Tian-Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Bernard P L Chan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Leonard L L Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Vijay K Sharma
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore.,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Benjamin Y Q Tan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1 E Kent Ridge Road, Singapore, 119228, Singapore. .,Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore.
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