Can anticoagulation therapy in cerebral venous thrombosis associated with Behçet's disease be stopped without
M Roriz1, I Crassard2, S Lechtman1
1Internal Medicine Department, Lariboisière Hospital, Paris VII University, 2 rue Ambroise Paré, 75475 Paris, France.
Insights
Stopping anticoagulation in Behçet
Area of Science:
- Neurology
- Rheumatology
- Vascular Medicine
Background:
- Cerebral venous thrombosis (CVT) treatment in Behçet's disease (BD) lacks consensus, particularly regarding anticoagulation.
- Optimal management strategies for BD-associated CVT require further investigation.
Purpose of the Study:
- To evaluate the safety and efficacy of discontinuing anticoagulation in patients with Behçet's disease-associated CVT.
- To assess the role of optimal Behçet's disease treatment in preventing CVT recurrence after anticoagulation cessation.
Main Methods:
- Retrospective case series of seven patients with Behçet's disease-associated CVT.
- Anticoagulation was stopped in all patients during follow-up.
- Patients received optimal Behçet's disease treatment, including corticosteroids and immunosuppressants.
Main Results:
- One of seven patients experienced a CVT relapse after anticoagulation cessation.
- Six patients remained relapse-free with optimal Behçet's disease treatment (steroids +/- immunosuppressants).
- Corticosteroids were identified as essential for managing BD-associated CVT.
Conclusions:
- Anticoagulant therapy can potentially be safely discontinued in Behçet's disease-associated CVT patients.
- Optimal treatment of Behçet's disease, particularly with corticosteroids, is crucial for preventing thrombotic events.
- Further research is warranted to confirm these findings in larger cohorts.
Abstract:
There is as yet no consensus on the treatment of cerebral venous thrombosis (CVT) in Behçet's disease, and the place of anticoagulation is also still being debated. This report is of a series of seven patients with Behçet's disease (BD)-associated CVT, for which anticoagulation was stopped, and discusses the possibility of stopping anticoagulation during follow-up while receiving optimal treatment for BD. The diagnosis of BD was established during follow-up, which lasted a median of 120 [range: 60-1490] days after CVT diagnosis. The median duration of anticoagulation therapy was 29.5 months. On stopping anticoagulation, concomitant treatment then included colchicine, steroids and azathioprine, all introduced after BD was diagnosed. With a median follow-up of 25 months after anticoagulation interruption, only one relapse of CVT was observed. No relapse of CVT or other venous thrombosis was observed in the six patients treated by steroids associated with an immunosuppressant or colchicine. Our results emphasize that corticosteroids are essential for the treatment of BD-associated CVT, and that anticoagulant therapy may be safely stopped during follow-up in the presence of optimal BD treatment (steroids alone or with immunosuppressive drugs).
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