Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study-Reference-Cited by-同舟云学术

Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study

Published:2022-03 Issue:3 Volume:53 Page:728-738
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Yaghi Shadi¹^ORCID,Shu Liqi¹^ORCID,Bakradze Ekaterina²^ORCID,Salehi Omran Setareh³^ORCID,Giles James A.⁴^ORCID,Amar Jordan Y.⁴,Henninger Nils⁵⁶^ORCID,Elnazeir Marwa⁵,Liberman Ava L.⁷^ORCID,Moncrieffe Khadean⁸^ORCID,Lu Jenny⁸^ORCID,Sharma Richa⁹^ORCID,Cheng Yee⁹,Zubair Adeel S.⁹,Simpkins Alexis N.¹⁰^ORCID,Li Grace T.¹⁰^ORCID,Kung Justin Chi¹⁰^ORCID,Perez Dezaray¹⁰^ORCID,Heldner Mirjam¹¹^ORCID,Scutelnic Adrian¹¹^ORCID,Seiffge David¹¹^ORCID,Siepen Bernhard¹¹,Rothstein Aaron¹²^ORCID,Khazaal Ossama¹²^ORCID,Do David¹²^ORCID,Kasab Sami Al¹³¹⁴^ORCID,Rahman Line Abdul¹³^ORCID,Mistry Eva A.¹⁵^ORCID,Kerrigan Deborah¹⁶^ORCID,Lafever Hayden¹⁶,Nguyen Thanh N.¹⁷^ORCID,Klein Piers¹⁵¹⁷^ORCID,Aparicio Hugo¹⁷^ORCID,Frontera Jennifer¹⁸^ORCID,Kuohn Lindsey¹⁸^ORCID,Agarwal Shashank¹⁸^ORCID,Stretz Christoph¹^ORCID,Kala Narendra¹,El Jamal Sleiman¹^ORCID,Chang Alison¹,Cutting Shawna¹^ORCID,Xiao Han¹⁹^ORCID,de Havenon Adam⁹^ORCID,Muddasani Varsha²⁰^ORCID,Wu Teddy²¹^ORCID,Wilson Duncan²¹,Nouh Amre²²,Asad Syed Daniyal²²^ORCID,Qureshi Abid²³^ORCID,Moore Justin²³^ORCID,Khatri Pooja^ORCID,Aziz Yasmin¹⁵^ORCID,Casteigne Bryce¹⁵^ORCID,Khan Muhib²⁴^ORCID,Cheng Yao²⁴,Mac Grory Brian²⁵^ORCID,Weiss Martin²⁵,Ryan Dylan²⁵^ORCID,Vedovati Maria Cristina²⁶,Paciaroni Maurizio²⁷^ORCID,Siegler James E.²⁸^ORCID,Kamen Scott²⁸^ORCID,Yu Siyuan²⁸^ORCID,Leon Guerrero Christopher R.²⁹^ORCID,Atallah Eugenie²⁹^ORCID,De Marchis Gian Marco³⁰^ORCID,Brehm Alex³¹^ORCID,Dittrich Tolga³⁰^ORCID,Psychogios Marios³¹^ORCID,Alvarado-Dyer Ronald³²^ORCID,Kass-Hout Tareq³²,Prabhakaran Shyam³²^ORCID,Honda Tristan³³^ORCID,Liebeskind David S.³³^ORCID,Furie Karen¹^ORCID

Affiliation:

1. Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.).

2. Department of Neurology, University of Alabama at Birmingham (E.B.).

3. Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O.).

4. Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.).

5. Department of Neurology (N.H., M.E.), University of Massachusetts, Worcester.

6. Department of Psychiatry (N.H.), University of Massachusetts, Worcester.

7. Department of Neurology, Weill Cornell Medical Center, NY (A.L.L.).

8. Department of Neurology, Montefiore Medical Center, NY (K.M., J.L.).

9. Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.).

10. Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.).

11. Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.).

12. Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.).

13. Department of Neurology (S.A.K., L.A.R.), Medical University of South Carolina, Charleston.

14. Department of Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston.

15. Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.).

16. Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.).

17. Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.).

18. Department of Neurology, New York University, NY (J.F., L.K., S.A.).

19. Department of Biostatistics, University of California Santa Barbara (H.X.).

20. Department of Neurology, University of Utah, Salt Lake City (V.M.).

21. Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.).

22. Department of Neurology, Hartford Hospital, CT (A.N., S.D.A.).

23. Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.).

24. Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.).

25. Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.).

26. Department of Medicine and Surgery, University of Perugia, Italy (M.C.V.).

27. Neurology – Stroke Unit, IRCCS MultiMedica, Milano, Italy (M.P.).

28. Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.).

29. Department of Neurology, George Washington University, District of Columbia (C.R.L.G., E.A.).

30. Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.).

31. Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.).

32. Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.).

33. Department of Neurology, University of California at Los Angeles (T.H., D.S.L.).

Abstract

Background: A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants (DOACs) to warfarin in a real-world CVT cohort. Methods: This multicenter international retrospective study (United States, Europe, New Zealand) included consecutive patients with CVT treated with oral anticoagulation from January 2015 to December 2020. We abstracted demographics and CVT risk factors, hypercoagulable labs, baseline imaging data, and clinical and radiological outcomes from medical records. We used adjusted inverse probability of treatment weighted Cox-regression models to compare recurrent cerebral or systemic venous thrombosis, death, and major hemorrhage in patients treated with warfarin versus DOACs. We performed adjusted inverse probability of treatment weighted logistic regression to compare recanalization rates on follow-up imaging across the 2 treatments groups. Results: Among 1025 CVT patients across 27 centers, 845 patients met our inclusion criteria. Mean age was 44.8 years, 64.7% were women; 33.0% received DOAC only, 51.8% received warfarin only, and 15.1% received both treatments at different times. During a median follow-up of 345 (interquartile range, 140–720) days, there were 5.68 recurrent venous thrombosis, 3.77 major hemorrhages, and 1.84 deaths per 100 patient-years. Among 525 patients who met recanalization analysis inclusion criteria, 36.6% had complete, 48.2% had partial, and 15.2% had no recanalization. When compared with warfarin, DOAC treatment was associated with similar risk of recurrent venous thrombosis (aHR, 0.94 [95% CI, 0.51–1.73]; P =0.84), death (aHR, 0.78 [95% CI, 0.22–2.76]; P =0.70), and rate of partial/complete recanalization (aOR, 0.92 [95% CI, 0.48–1.73]; P =0.79), but a lower risk of major hemorrhage (aHR, 0.35 [95% CI, 0.15–0.82]; P =0.02). Conclusions: In patients with CVT, treatment with DOACs was associated with similar clinical and radiographic outcomes and favorable safety profile when compared with warfarin treatment. Our findings need confirmation by large prospective or randomized studies.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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