Comparing the effectiveness and safety of direct oral anticoagulants and warfarin in patients with cerebral venous thrombosis: A real-world study

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-03-14 DOI:10.1016/j.jstrokecerebrovasdis.2025.108290

Jheng-yan Wu , Chih-cheng Lai , Huey-Juan Lin , Kuan-Hsien Lu , Wan-Hsuan Hsu , Ting-ying Chu

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引用次数: 0

Abstract

Background

Cerebral venous thrombosis (CVT), a rare stroke variant, poses treatment challenges, especially in young individuals. While guidelines recommend heparin followed by warfarin, warfarin has limitations. Direct oral anticoagulants (DOACs) offer a potential alternative, but evidence on their use in CVT management is limited. The TriNetX study aimed to provide real-world insights into DOAC efficacy and safety for CVT.

Methods

We conducted a retrospective cohort study utilizing data from TriNetX to identify patients with CVT. Propensity score matching (PSM) was used to balance the covariates between patients receiving DOACs and those receiving warfarin. The primary outcome was recurrent CVT, with secondary outcomes including intracerebral hemorrhage and all-cause mortality.

Results

Among 1,507 patients with CVT, PSM generated 551 matched individuals in both the study and control groups. The study group that received DOACs exhibited a lower risk of CVT recurrence (Hazard Ratio [HR], 0.77; 95 % Confidence Interval [CI], 0.628–0.97) and a higher 360-day event-free survival rate (p < 0.001). Subgroup analyses revealed significantly reduced recurrent CVT risk in the study group, particularly among females (HR, 0.67; 95 % CI, 0.50-0.89), individuals aged 41–64 years (HR, 0.52; 95 % CI, 0.35–0.75), and patients with normal weight (HR, 0.65; 95 % CI, 0.50–0.84). Moreover, recipients of DOACs had a lower risk of intracerebral hemorrhage (HR, 0.62; 95 % CI, 0.43–0.91) and comparable all-cause mortality (HR, 1.03; 95 % CI, 0.67-1.59).

Conclusions

This study underscores the potential of DOACs as a promising treatment for CVT, demonstrating reduced recurrence and intracerebral hemorrhage risks with comparable all-cause mortality.

查看原文本刊更多论文

比较直接口服抗凝剂和华法林治疗脑静脉血栓患者的有效性和安全性：一项真实世界的研究。

背景：脑静脉血栓形成（CVT）是一种罕见的脑卒中变体，对治疗提出了挑战，特别是在年轻人中。虽然指南建议在使用肝素后再使用华法林，但华法林有局限性。直接口服抗凝剂（DOACs）提供了一种潜在的替代方案，但其在CVT治疗中的应用证据有限。TriNetX研究旨在为DOAC治疗CVT的有效性和安全性提供真实的见解。方法：我们利用TriNetX的数据进行了一项回顾性队列研究，以确定CVT患者。使用倾向评分匹配（PSM）来平衡doac患者和华法林患者之间的协变量。主要结局是复发性CVT，次要结局包括脑出血和全因死亡率。结果：在1507例CVT患者中，PSM在研究组和对照组中产生了551例匹配个体。接受DOACs的研究组CVT复发的风险较低(危险比[HR]， 0.77；95%可信区间[CI]， 0.628-0.97)和更高的360天无事件生存率（p < 0.001）。亚组分析显示，研究组复发性CVT风险显著降低，尤其是女性(HR, 0.67；95% CI, 0.50-0.89)， 41-64岁个体(HR, 0.52；95% CI, 0.35-0.75)，以及体重正常的患者(HR, 0.65；95% ci, 0.50-0.84)。此外，DOACs接受者发生脑出血的风险较低(HR, 0.62；95% CI, 0.43-0.91)和可比全因死亡率(HR, 1.03；95% ci, 0.67-1.59)。结论：该研究强调了DOACs作为CVT治疗的潜力，显示出降低复发和脑出血风险，并具有相当的全因死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.