Articles

Introduction: Cerebral venous thrombosis is a rare type of stroke caused by partial or complete occlusion of cerebral venous sinuses. Current guidelines recommend the administration of Low Molecular Weight Heparin (LMWH) during the acute phase and oral Vitamin K antagonists (VKAs) such as warfarin for 3-12 months. Direct Oral Anticoagulants (DOACs) are an attractive alternative to VKAs as therapy for CVT, for its safety and efficacy as anticoagulation therapy for deep venous thrombosis or pulmonary embolism. Method: This systematic review is written based on PRISMA guidelines with electronic search performed on various databases for journals published from June 1, 2018 to June 1, 2023. Results: We found four studies fulfilling the inclusion criteria, with four randomized controlled studies presenting 179 CVT patients treated with DOAC and 150 patients treated with standard therapy. DOACs used in reviewed studies are Dabigatran and Rivaroxaban. Discussion: Administration of DOACs as anticoagulation therapy in patients with CVT presents better recanalization rate with no significant differences in efficacy compared with VKAs, along with a better safety profile through similar mortality rate across two groups. Conclusion: DOACs as long-term anticoagulation therapy in patients with CVT has better efficacy along with a similar safety profile compared to VKA.

Objectives: There remains no consensus management for isolated distal deep vein thrombosis (IDDVT), with current data inconclusive and dating back to the warfarin era. In the current direct oral anticoagulant (DOAC) era, optimal management of IDDVT needs to be re-assessed. Methods: A retrospective evaluation of patients treated with therapeutic anticoagulation for IDDVT in the DOAC era (2013-2016) was compared with historically published data from the warfarin era (2011-2012). Results: 247 patients were evaluated, 103 from the DOAC era and 122 from the warfarin era. There were less provoked events in the DOAC cohort (45.6% vs 66.7%, p=<0.01). Overall rate of major bleeding was 1.6% with 1.0% in the DOAC era and 2.1% in the warfarin era (p=0.50). There was no difference in rates of VTE progression on treatment 5.8% vs 4.9% respectively (p=0.91). Overall risk of VTE recurrence post cessation was 5.3% (1.86 per 100 person years) with no difference between groups (5.8% vs 4.9%, p=0.74). Conclusions: Our data shows IDDVT is not always benign, with risk of extension despite treatment and long-term risk of VTE-recurrence. Therapeutic anticoagulation with DOAC in these patients was associated with a major bleeding rate of 1.0% in the DOAC cohort. Further clinical trials into the optimal IDDVT management in the DOAC era are necessary.