Shishir Keekana Rao1, Mohammad Ibrahim1, Claudia M Hanni2, Kushak Suchdev1, Dennis Parker2, Kumar Rajamani1, Wazim Mohamed3. 1. Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI 48201, United States. 2. Department of Pharmacology, Wayne State University, Detroit Medical Center, Detroit, MI 48201, United States. 3. Department of Neurology, Wayne State University/Detroit Medical Center, Detroit, MI 48201, United States. Electronic address: wmohamed@med.wayne.edu.
Abstract
BACKGROUND: Venous thrombosis affecting cerebral veins and sinuses (CVT) is an uncommon neurological condition. Traditionally patients are treated with intravenous heparin followed by an oral vitamin K antagonist like warfarin. Direct oral anticoagulants (DOACs) may offer advantages over warfarin. There is evidence to demonstrate the effectiveness of both dabigatran and rivaroxaban. No data, however, has been published describing the use of apixaban in patients with CVT. METHODS: Report of three cases of CVT and review literature on available treatment options; efficacy and safety of novel oral anticoagulants in patients with systemic thrombosis. RESULTS: All patients presented with typical features of CVT. After confirming the diagnosis, they were acutely treated with heparin and later discharged on apixaban. During follow up visits, they tolerated apixaban well and did not have any bleeding complications. Follow up scans showed resolution of the thrombus and recanalization. CONCLUSION: CVT is an uncommon neurological condition and is often complicated by associated intraparenchymal hemorrhage. Although not recommended in current guidelines, apixaban may be a safe and effective option for the treatment of CVT.
BACKGROUND:Venous thrombosis affecting cerebral veins and sinuses (CVT) is an uncommon neurological condition. Traditionally patients are treated with intravenous heparin followed by an oral vitamin K antagonist like warfarin. Direct oral anticoagulants (DOACs) may offer advantages over warfarin. There is evidence to demonstrate the effectiveness of both dabigatran and rivaroxaban. No data, however, has been published describing the use of apixaban in patients with CVT. METHODS: Report of three cases of CVT and review literature on available treatment options; efficacy and safety of novel oral anticoagulants in patients with systemic thrombosis. RESULTS: All patients presented with typical features of CVT. After confirming the diagnosis, they were acutely treated with heparin and later discharged on apixaban. During follow up visits, they tolerated apixaban well and did not have any bleeding complications. Follow up scans showed resolution of the thrombus and recanalization. CONCLUSION:CVT is an uncommon neurological condition and is often complicated by associated intraparenchymal hemorrhage. Although not recommended in current guidelines, apixaban may be a safe and effective option for the treatment of CVT.
Authors: Gauruv Bose; Justin Graveline; Vignan Yogendrakumar; Risa Shorr; Dean A Fergusson; Gregoire Le Gal; Jonathan Coutinho; Marcelo Mendonça; Miguel Viana-Baptista; Simon Nagel; Dar Dowlatshahi Journal: BMJ Open Date: 2021-02-16 Impact factor: 2.692
Authors: Diego Chemello; Larissa Rosa; Amanda Faria de Araujo; Pedro Cargnelutti de Araujo; Luiz Carlos Carneiro Pereira; Suélen Feijó Hillesheim; Marco Aurélio Lumertz Saffi Journal: J Vasc Bras Date: 2021-04-28