Direct oral anticoagulants compared to warfarin in long‐term management of cerebral venous thrombosis: A comprehensive meta‐analysis

Author:

Ranjan Redoy12ORCID,Ken‐Dror Gie2,Sharma Pankaj23

Affiliation:

1. Department of Cardiac Surgery Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

2. Institute of Cardiovascular Research Royal Holloway University of London (ICR2UL) Greater London UK

3. Department of Clinical Neurology Imperial College London Healthcare NHS Trust London UK

Abstract

AbstractObjectivesWe compared the safety and efficacy of direct oral anticoagulants (DOACs) with those of warfarin in the long‐term (≥6 months) treatment of cerebral venous thrombosis (CVT).MethodsWe searched electronic databases up to November 2023 to compare the use of DOACs and warfarin in CVT management. Modified Rankin scores (mRS), new intracranial hemorrhage, all‐cause mortality, recurrence and nonrecanalisation events were used to assess outcome. RevMan v5.4 software and the Cochran‐Mantel‐Haenszel method were utilized to analyse data.ResultsA total of 25 studies involving 2301 patients were identified as having treated CVT with either DOACs or warfarin. Good long‐term mRS scores 0–2 (risk ratio [RR] = 1.01, 95% CI = 0.98–1.03; p = 0.61), new intracranial hemorrhage (RR = 1.00, 95% CI = 0.48–2.08; p = 0.99), all‐cause mortality (RR = 1.00, 95% CI = 0.50–1.98; p = 0.99), nonrecanalisation (RR = 0.95, 95% CI = 0.77–1.18; p = 0.65) and recurrence venous thrombosis events (RR = 0.63, 95% CI = 0.33–1.22; p = 0.17) were similar between the two treatment arms. Subgroup analysis found recurrence of venous thrombosis was lower in the rivaroxaban group compared to warfarin (2.2% vs. 8.5%, RR = 0.33, 95% CI = 0.11–0.98; p = 0.05).ConclusionDOACs and warfarin provide comparable long‐term safety and efficacy profiles. DOACs may be preferred over warfarin due to their ease of clinical management.

Publisher

Wiley

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