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Predictors of Recurrent Venous Thrombosis After Cerebral Venous Thrombosis: Analysis of the ACTION-CVT Study
Liqi Shu1, Ekaterina Bakradze1, Setareh Salehi Omran1
1From the Department of Neurology (L.S., C.S., N.K., S.E., A.C., S.C., F.I., K.F., Shadi Yaghi), Brown University, Providence, RI; Department of Neurology (E.B.), University of Alabama at Birmingham; Department of Neurology (S.S.O.), University of Colorado School of Medicine, Aurora; Department of Neurology (J.G., J.A.), Washington University, Saint Louis, MO; Departments of Neurology (N.H., M.D.M.), and Psychiatry (N.H.), University of Massachusetts, Worcester; Department of Neurology (A.L.), Weill Cornell Medical Center, New York, NY; Department of Neurology (K.M., J.R.), Montefiore Medical Center, New York, NY; Department of Neurology (R.S., Yee Cheng, A.S.Z., A.H.), Yale University, New Haven, CT; Department of Neurology (Alexis Simpkins, G.L., J.K., D.P.), University of Florida, Gainesville; Department of Neurology (M.R.H., Adrian Scutelnic, R.M., B.S.), Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland; Department of Neurology (A.R., O.K., D.D.), University of Pennsylvania, Philadelphia; Departments of Neurology (S.A.K., L.A.R.) and Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston; Department of Neurology and Rehabilitation Medicine (E.A.M., Pooja Khatri, Y.A., B.C.), University of Cincinnati; Department of Neurology (D.K., H.L.), Vanderbilt University, Nashville, TN; Department of Neurology (T.N.N., Piers Klein, H.J.A.), Boston University School of Medicine, MA; Department of Neurology (J.A.F., L.K., S.A.), New York University, NY; Department of Neurology (V.M.), University of Utah, Salt Lake City; Department of Neurology (T.W., D.W.), Christchurch Hospital, New Zealand; Department of Neurology (A.N., D.A.), Hartford Hospital, CT; Department of Neurology (A.Q., J.M.), University of Kansas, Kansas City; Department of Neurology (M.K., Yao Cheng), Spectrum Health, Michigan State University, Grand Rapids, MI; Department of Neurology (B.M.G., M.W., D.R.), Duke University, Durham, NC; Department of Medicine and Surgery (M.C.V.), University of Perugia, Italy, University of Perugia, Italy; Neurology-Stroke Unit (Maurizio Paciaroni), IRCCS MultiMedica, Milano, Italy; Cooper Neurologic Institute (J.S., S.K., Siyuan Yu), Cooper University, Camden, NJ; Department of Neurology (C.L.G., E.A.), George Washington University, District of Columbia; Department of Neurology (G.M.D.M., T.D.), University Hospital Basel and University of Basel, Switzerland; Department of Interventional and Diagnostic Neuroradiology (A.B., Marios Psychogios), Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Neurology (R.A.-D., T.K.-H., S.P.), University of Chicago, IL; and Department of Neurology (T.H., D.L.), University of California at Los Angeles.
Background And Objective:
Cerebral venous thrombosis (CVT) is a rare cause of stroke carrying a nearly 4% risk of recurrence after 1 year. There are limited data on predictors of recurrent venous thrombosis in patients with CVT. In this study, we aim to identify those predictors.
Methods:
This is a secondary analysis of the ACTION-CVT study which is a multicenter international study of consecutive patients hospitalized with a diagnosis of CVT over a 6-year period. Patients with cancer-associated CVT, CVT during pregnancy, or CVT in the setting of known antiphospholipid antibody syndrome were excluded per the ACTION-CVT protocol. The study outcome was recurrent venous thrombosis defined as recurrent venous thromboembolism (VTE) or de novo CVT. We compared characteristics between patients with vs without recurrent venous thrombosis during follow-up and performed adjusted Cox regression analyses to determine important predictors of recurrent venous thrombosis.
Results:
Nine hundred forty-seven patients were included with a mean age of 45.2 years, 63.9% were women, and 83.6% had at least 3 months of follow-up. During a median follow-up of 308 (interquartile range 120-700) days, there were 5.05 recurrent venous thromboses (37 VTE and 24 de novo CVT) per 100 patient-years. Predictors of recurrent venous thrombosis were Black race (adjusted hazard ratio [aHR] 2.13, 95% CI 1.14-3.98, p = 0.018), history of VTE (aHR 3.40, 95% CI 1.80-6.42, p < 0.001), and the presence of one or more positive antiphospholipid antibodies (aHR 3.85, 95% CI 1.97-7.50, p < 0.001). Sensitivity analyses including events only occurring on oral anticoagulation yielded similar findings.
Discussion:
Black race, history of VTE, and the presence of one or more antiphospholipid antibodies are associated with recurrent venous thrombosis among patients with CVT. Future studies are needed to validate our findings to better understand mechanisms and treatment strategies in patients with CVT.
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