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Anticoagulation for cavernous sinus thrombosis: a systematic review and individual patient data meta-analysis
Chatdanai Akarapas1, Nutchar Wiwatkunupakarn2, Suchanya Sithirungson3
1Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. chatdanai.a@cmu.ac.th.
Insights
Anticoagulation therapy significantly reduces mortality in adult patients with septic cavernous sinus thrombosis (SCST). This review suggests heparin is a common initial treatment, with prolonged use potentially improving outcomes.
Area of Science:
- Medical research
- Clinical treatment
- Systematic review and meta-analysis
Background:
- Septic cavernous sinus thrombosis (SCST) is a rare but severe condition with high mortality and morbidity.
- The efficacy of anticoagulation in treating SCST is not well-established due to limited evidence.
Purpose of the Study:
- To investigate the association between anticoagulation and mortality in patients with cavernous sinus thrombosis originating from sinusitis.
- To identify the types and duration of anticoagulation therapies employed in SCST cases.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA guidelines.
- Inclusion of adult patients (≥18 years) diagnosed with SCST, confirmed by objective methods.
- Data extraction from 72 articles comprising 110 patients, with logistic regression for confounding factor adjustment.
Main Results:
- A significantly lower mortality rate was observed in patients receiving anticoagulation (3.3% vs. 18%, p=0.022).
- The adjusted odds ratio for mortality in the anticoagulation group was 0.067 (95% CI: 0.009–0.475).
- Heparin was the most frequent initial anticoagulant, with one-third of patients treated for three months.
Conclusions:
- Anticoagulation therapy shows a strong potential to improve survival rates in adult patients diagnosed with SCST.
- Careful consideration of hyperglycemia is recommended before initiating anticoagulation in SCST patients.
Purpose:
Septic cavernous sinus thrombosis (SCST) is a rare but life-threatening condition with high mortality and morbidity. The role of anticoagulation in the treatment of SCST remains unclear because there is limited evidence to support this treatment. This study aims to explore (1) the association between anticoagulation administration and mortality of cavernous sinus thrombosis from sinusitis, and (2) the types and duration of anticoagulation used.
Methods:
This review was undertaken and reported in accordance with PRISMA guidelines. We included the studies that reported individual data of adult patients (≥ 18 years) diagnosed with cavernous sinus thrombosis from sinusitis confirmed by objective methods with documented therapy and outcome. A systematic search carried out in Embase, Medline, Scopus, and CENTRAL by two reviewers up to Dec 2023. The quality was evaluated using tool proposed by Murad et al. The logistic regression analysis was employed to adjust the confounding factors.
Results:
A total of 72 articles with 110 patients, were eligible for inclusion in our meta-analysis. There was a significant difference less mortality in the group that received anticoagulants (3.3 vs. 18%, p = 0.022). The adjusted odds ratio for mortality in the anticoagulant-given group is 0.067 (0.009, 0.475). Heparin is the most frequently used initial agent and one-third of patients receiving anticoagulants for three months.
Conclusion:
In an adult patient diagnosed with cavernous sinus thrombosis, there was a strong suggestion that anticoagulation could improve mortality. We recommend that patients with hyperglycemia should be carefully considered before receiving an anticoagulant.
