Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

Objectives Current guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT.Data sources MEDLINE, Embase and COC...

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Main Authors: Gauruv Bose, Justin Graveline, Marcelo Mendonça
Format: Article
Language:English
Published: BMJ Publishing Group 2021-02-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/11/2/e040212.full
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spelling doaj-2da89e231f964bd9b8c3283fb66cc4332021-06-25T13:34:04ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2020-040212Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic reviewGauruv Bose0Justin Graveline1Marcelo Mendonça2Department of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Medicine, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Neurology, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, NOVA Medical School, NMS, Universidade Nova de Lisboa, Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, PortugalObjectives Current guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT.Data sources MEDLINE, Embase and COCHRANE databases up to 18 November 2020.Eligibility criteria All published articles of patients with CVT treated with DOAC were included. Studies without follow-up information were excluded.Data extraction and synthesis Two independent reviewers screened articles and extracted data. A risk of bias analysis was performed.Primary and secondary outcome measures Safety data included mortality, intracranial haemorrhage (ICH) or other adverse events. Efficacy data included recurrent CVT, recanalisation rates and disability by modified Rankin Scales (mRS).Results 33 studies met inclusion criteria. One randomised controlled trial, 5 observational cohorts and 27 case series or studies reported 279 patients treated with DOAC for CVT: 41% dabigatran, 47% rivaroxaban, 10% apixaban and 2% edoxaban, in addition to 315 patients treated with standard therapy. The observational cohorts showed a similar risk of death in DOAC and standard therapy arms (RR 2.12, 95% CI 0.29 to 15.59). New ICH was reported in 2 (0.7%) DOAC-treated patients and recurrent CVT occurred in 4 (1.5%). A favourable mRS between 0 and 2 was reported in 94% of DOAC-treated patients, more likely than standard therapy in observational cohorts (RR 1.13, 95% CI 1.02 to 1.25).Conclusion The evidence for DOAC use in CVT is limited although suggests sufficient safety and efficacy despite variability in timing and dose of treatment. This systematic review highlights that further rigorous trials are needed to validate these findings and to determine optimal treatment regimens.https://bmjopen.bmj.com/content/11/2/e040212.full
collection DOAJ
language English
format Article
sources DOAJ
author Gauruv Bose
Justin Graveline
Marcelo Mendonça
spellingShingle Gauruv Bose
Justin Graveline
Marcelo Mendonça
Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
BMJ Open
author_facet Gauruv Bose
Justin Graveline
Marcelo Mendonça
author_sort Gauruv Bose
title Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
title_short Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
title_full Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
title_fullStr Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
title_full_unstemmed Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
title_sort direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review
publisher BMJ Publishing Group
series BMJ Open
issn 2044-6055
publishDate 2021-02-01
description Objectives Current guidelines do not recommend direct oral anticoagulants (DOACs) to treat cerebral venous thrombosis (CVT) despite their benefits over standard therapy. We performed a systematic review to summarise the published experience of DOAC therapy in CVT.Data sources MEDLINE, Embase and COCHRANE databases up to 18 November 2020.Eligibility criteria All published articles of patients with CVT treated with DOAC were included. Studies without follow-up information were excluded.Data extraction and synthesis Two independent reviewers screened articles and extracted data. A risk of bias analysis was performed.Primary and secondary outcome measures Safety data included mortality, intracranial haemorrhage (ICH) or other adverse events. Efficacy data included recurrent CVT, recanalisation rates and disability by modified Rankin Scales (mRS).Results 33 studies met inclusion criteria. One randomised controlled trial, 5 observational cohorts and 27 case series or studies reported 279 patients treated with DOAC for CVT: 41% dabigatran, 47% rivaroxaban, 10% apixaban and 2% edoxaban, in addition to 315 patients treated with standard therapy. The observational cohorts showed a similar risk of death in DOAC and standard therapy arms (RR 2.12, 95% CI 0.29 to 15.59). New ICH was reported in 2 (0.7%) DOAC-treated patients and recurrent CVT occurred in 4 (1.5%). A favourable mRS between 0 and 2 was reported in 94% of DOAC-treated patients, more likely than standard therapy in observational cohorts (RR 1.13, 95% CI 1.02 to 1.25).Conclusion The evidence for DOAC use in CVT is limited although suggests sufficient safety and efficacy despite variability in timing and dose of treatment. This systematic review highlights that further rigorous trials are needed to validate these findings and to determine optimal treatment regimens.
url https://bmjopen.bmj.com/content/11/2/e040212.full
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