Direct oral anticoagulants in the treatment of cerebral venous sinus thrombosis: a single institution’s experience

Aim of the study. Oral anticoagulants, preferentially vitamin K antagonists (VKA), are recommended for 3–12 months in patients with cerebral venous sinus thrombosis (CVST). We present a series of patients with CVST treated with direct oral anticoagulants (DOAC). Materials and methods. We prospectively recruited 36 patients with CVST (aged 40.3 ± 9.2 years, 58.3% female) treated with DOAC based on the physician’s or patient’s preferences. Functional outcome was assessed with modified Rankin Scale. Recanalisation was assessed on imaging at 3–6 months post the event. Patients were followed for a median of 30 [interquartile range (IQR) 25–37] months. Results. After use of heparin (median: 6 days; IQR 5–8.75), patients received dabigatran (150 mg bid, n = 16 or 110 mg bid, n = 2), rivaroxaban (20 mg qd, n = 10) or apixaban (5 mg bid, n = 8) for a median of 8.5 months (IQR 6.25–12). Complete or partial recanalisation was observed in 34 cases (94.4%). Three patients (8.3%) experienced major bleeding: menorrhagia on rivaroxaban (n = 2) and gastrointestinal bleeding on dabigatran (n = 1). A favourable functional outcome was observed in 24 (66.7%) patients, without any fatality. CSVT recurred in two patients (5.6%) and two venous thromboses developed in two other patients with inherited thrombophilia after anticoagulation withdrawal. Conclusions and clinical implications. DOACs could be an alternative to VKA in CVST patients