{"title":"Anticoagulation for cavernous sinus thrombosis: a systematic review and individual patient data meta-analysis.","authors":"Chatdanai Akarapas, Nutchar Wiwatkunupakarn, Suchanya Sithirungson, Saisawat Chaiyasate","doi":"10.1007/s00405-024-08992-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition with high mortality and morbidity. The role of anticoagulation in the treatment of SCST remains unclear because there is limited evidence to support this treatment. This study aims to explore (1) the association between anticoagulation administration and mortality of cavernous sinus thrombosis from sinusitis, and (2) the types and duration of anticoagulation used.</p><p><strong>Methods: </strong>This review was undertaken and reported in accordance with PRISMA guidelines. We included the studies that reported individual data of adult patients (≥ 18 years) diagnosed with cavernous sinus thrombosis from sinusitis confirmed by objective methods with documented therapy and outcome. A systematic search carried out in Embase, Medline, Scopus, and CENTRAL by two reviewers up to Dec 2023. The quality was evaluated using tool proposed by Murad et al. The logistic regression analysis was employed to adjust the confounding factors.</p><p><strong>Results: </strong>A total of 72 articles with 110 patients, were eligible for inclusion in our meta-analysis. There was a significant difference less mortality in the group that received anticoagulants (3.3 vs. 18%, p = 0.022). The adjusted odds ratio for mortality in the anticoagulant-given group is 0.067 (0.009, 0.475). Heparin is the most frequently used initial agent and one-third of patients receiving anticoagulants for three months.</p><p><strong>Conclusion: </strong>In an adult patient diagnosed with cavernous sinus thrombosis, there was a strong suggestion that anticoagulation could improve mortality. We recommend that patients with hyperglycemia should be carefully considered before receiving an anticoagulant.</p>","PeriodicalId":11952,"journal":{"name":"European Archives of Oto-Rhino-Laryngology","volume":" ","pages":"1127-1134"},"PeriodicalIF":1.9000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Archives of Oto-Rhino-Laryngology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00405-024-08992-4","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/23 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose: Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition with high mortality and morbidity. The role of anticoagulation in the treatment of SCST remains unclear because there is limited evidence to support this treatment. This study aims to explore (1) the association between anticoagulation administration and mortality of cavernous sinus thrombosis from sinusitis, and (2) the types and duration of anticoagulation used.
Methods: This review was undertaken and reported in accordance with PRISMA guidelines. We included the studies that reported individual data of adult patients (≥ 18 years) diagnosed with cavernous sinus thrombosis from sinusitis confirmed by objective methods with documented therapy and outcome. A systematic search carried out in Embase, Medline, Scopus, and CENTRAL by two reviewers up to Dec 2023. The quality was evaluated using tool proposed by Murad et al. The logistic regression analysis was employed to adjust the confounding factors.
Results: A total of 72 articles with 110 patients, were eligible for inclusion in our meta-analysis. There was a significant difference less mortality in the group that received anticoagulants (3.3 vs. 18%, p = 0.022). The adjusted odds ratio for mortality in the anticoagulant-given group is 0.067 (0.009, 0.475). Heparin is the most frequently used initial agent and one-third of patients receiving anticoagulants for three months.
Conclusion: In an adult patient diagnosed with cavernous sinus thrombosis, there was a strong suggestion that anticoagulation could improve mortality. We recommend that patients with hyperglycemia should be carefully considered before receiving an anticoagulant.
期刊介绍:
Official Journal of
European Union of Medical Specialists – ORL Section and Board
Official Journal of Confederation of European Oto-Rhino-Laryngology Head and Neck Surgery
"European Archives of Oto-Rhino-Laryngology" publishes original clinical reports and clinically relevant experimental studies, as well as short communications presenting new results of special interest. With peer review by a respected international editorial board and prompt English-language publication, the journal provides rapid dissemination of information by authors from around the world. This particular feature makes it the journal of choice for readers who want to be informed about the continuing state of the art concerning basic sciences and the diagnosis and management of diseases of the head and neck on an international level.
European Archives of Oto-Rhino-Laryngology was founded in 1864 as "Archiv für Ohrenheilkunde" by A. von Tröltsch, A. Politzer and H. Schwartze.