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...
Main Authors: | , , |
---|---|
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 |
id |
doaj-2da89e231f964bd9b8c3283fb66cc433 |
---|---|
record_format |
Article |
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 |
work_keys_str_mv |
AT gauruvbose directoralanticoagulantsintreatmentofcerebralvenousthrombosisasystematicreview AT justingraveline directoralanticoagulantsintreatmentofcerebralvenousthrombosisasystematicreview AT marcelomendonca directoralanticoagulantsintreatmentofcerebralvenousthrombosisasystematicreview |
_version_ |
1721359653039767552 |