Direct oral anticoagulants for the treatment of cerebral venous thrombosis – a protocol of an international phase IV study

IntroductionCurrent guidelines recommend that patients with cerebral venous thrombosis (CVT) should be treated with vitamin K antagonists (VKAs) for 3–12 months. Direct oral anticoagulants (DOACs), however, are increasingly used in clinical practice. An exploratory randomized controlled trial including 120 patients with CVT suggested that the efficacy and safety profile of dabigatran (a DOAC) is similar to VKAs for the treatment of CVT, but large-scale prospective studies from a real-world setting are lacking.MethodsDOAC-CVT is an international, prospective, observational cohort study comparing DOACs to VKAs for the prevention of recurrent venous thrombotic events after acute CVT. Patients are eligible if they are 18 years or older, have a radiologically confirmed CVT, and have started oral anticoagulant treatment (DOAC or VKA) within 30 days of CVT diagnosis. Patients with an absolute contra-indication for DOACs, such as pregnancy or severe renal insufficiency, are excluded from the study. We aim to recruit at least 500 patients within a three-year recruitment period. The primary endpoint is a composite of recurrent venous thrombosis and major bleeding at 6 months of follow-up. We will calculate an adjusted odds ratio for the primary endpoint using propensity score inverse probability treatment weighting.DiscussionDOAC-CVT will provide real-world data on the comparative efficacy and safety of DOACs versus VKAs for the treatment of CVT.Clinical trial registrationClinicalTrials.gov, NCT04660747

Aneurisma de la arteria comunicante posterior y parálisis del III nervio craneal. Caso clínico y revisión de la literatura

Objective: Case report of posterior communicating artery aneurysm (ACoP) related unilateral oculomotor nerve palsy (ONP). Introduction: The ACoP aneurysms represents the 25% of all aneurysms. It could cause ONP because of his close relation of the aneurysm and the oculomotor nerve. The treatment in symptomatic patients should be the exclusion of the aneurysm. Case report: 38-year-old woman with headache of 15 days of evolution and acute ONP. CT angiography shows a 3x7 mm ACoP aneurysm. Microsurgery and clipping were considered the best treatment and were realized without complications. The patient evolves with complete recovery of his ONP with complete exclusion of the aneurysm. Discussion: ACoP aneurysm should be considered in ONP working diagnosis. The treatment is exclusion of the aneurism either by endovascular or microsurgical techniques. Microsurgical clipping has shown better functional outcomes than endovascular therapy