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Timing and Predictors of Recanalization After Anticoagulation in Cerebral Venous Thrombosis
Setareh Salehi Omran1, Liqi Shu2, Allison Chang2
1Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
Recanalization after cerebral venous thrombosis (CVT) is often incomplete in older males and those without parenchymal changes. Most recanalization occurs within 3 months of diagnosis, with limited benefit thereafter.
Area of Science:
- Neurology
- Vascular Medicine
- Radiology
Background:
- Cerebral venous thrombosis (CVT) recanalization correlates with better outcomes.
- Predictors and timing of CVT recanalization remain incompletely understood.
- Existing studies show mixed results on CVT recanalization factors.
Purpose of the Study:
- To identify predictors of recanalization after CVT.
- To determine the optimal timing for recanalization post-CVT.
- To analyze factors influencing recanalization in CVT patients.
Main Methods:
- Utilized data from the international ACTION-CVT study (2015-2020).
- Included patients with repeat venous neuroimaging >30 days post-anticoagulation initiation.
- Performed univariate and multivariable analyses to find predictors of failed recanalization.
Main Results:
- Among 551 patients, 88.2% showed partial or complete recanalization.
- Older age, male sex, and absence of baseline parenchymal changes predicted failed recanalization.
- Most recanalization (71.1%) occurred within 3 months; 59.0% achieved complete recanalization by 3 months.
Conclusions:
- Older age, male sex, and lack of parenchymal changes are associated with poor recanalization after CVT.
- Early recanalization within 3 months is most common.
- Further research is needed to validate these findings in prospective studies.
Background And Purpose:
Vessel recanalization after cerebral venous thrombosis (CVT) is associated with favorable outcomes and lower mortality. Several studies examined the timing and predictors of recanalization after CVT with mixed results. We aimed to investigate predictors and timing of recanalization after CVT.
Methods:
We used data from the multicenter, international AntiCoagulaTION in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT) study of consecutive patients with CVT from January 2015 to December 2020. Our analysis included patients that had undergone repeat venous neuroimaging more than 30 days after initiation of anticoagulation treatment. Prespecified variables were included in univariate and multivariable analyses to identify independent predictors of failure to recanalize.
Results:
Among the 551 patients (mean age, 44.4±16.2 years, 66.2% women) that met inclusion criteria, 486 (88.2%) had complete or partial, and 65 (11.8%) had no recanalization. The median time to first follow-up imaging study was 110 days (interquartile range, 60-187). In multivariable analysis, older age (odds ratio [OR], 1.05; 95% confidence interval [CI], 1.03-1.07), male sex (OR, 0.44; 95% CI, 0.24-0.80), and lack of parenchymal changes on baseline imaging (OR, 0.53; 95% CI, 0.29-0.96) were associated with no recanalization. The majority of improvement in recanalization (71.1%) occurred before 3 months from initial diagnosis. A high percentage of complete recanalization (59.0%) took place within the first 3 months after CVT diagnosis.
Conclusion:
Older age, male sex, and lack of parenchymal changes were associated with no recanalization after CVT. The majority recanalization occurred early in the disease course suggesting limited further recanalization with anticoagulation beyond 3 months. Large prospective studies are needed to confirm our findings.
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