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Anticoagulation Status and Outcome in Cerebral Venous Thrombosis: A Single-Center Retrospective Study from South
Deepak Menon1, Manisha Gupta1, Sangeeth Thuppanattumadam Ananthasubramanian1
1Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
Insights
Intensive anticoagulation may not be necessary for cerebral venous thrombosis (CVT) treatment. Lower intensity anticoagulation showed good outcomes in most patients, especially with treatable causes of CVT.
Area of Science:
- Neurology
- Vascular Medicine
- Thrombosis Research
Background:
- Cerebral venous thrombosis (CVT) treatment typically involves anticoagulation.
- Evidence for optimal anticoagulation intensity and duration in CVT is limited.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of anticoagulation in patients with cerebral venous thrombosis.
- To assess the relationship between anticoagulation intensity and patient outcomes in CVT.
Main Methods:
- Retrospective data collection from 204 CVT patients over a 5-year period.
- Analysis of demographic, clinical, radiological data, and anticoagulation status (INR).
- Minimum 6-month follow-up with at least three INR values recorded.
Main Results:
- Mean age of patients was 34.4 years; 95.1% had provoked CVT.
- Anticoagulation (acenocoumarol/warfarin) maintained for a mean of 16 months.
- Low time in therapeutic range (INR 2-3: 5.1%), high time in subtherapeutic range (INR 1-1.5: 68.7%).
- Good outcome in 89.7% of patients; CVT grading scale score predicted outcome.
Conclusions:
- Intensive anticoagulation may not be essential for CVT management.
- Lower intensity anticoagulation appears effective, particularly when CVT is provoked by transient, treatable factors.
Background And Objectives:
Early initiation and maintenance of anticoagulation appears to be the mainstay of treatment of cerebral venous thrombosis (CVT), but the evidence supporting the intensity and duration of anticoagulation is limited.
Methods:
We retrospectively collected data of patients admitted with CVT over a 5-year period, who had a minimum of 6 months of clinical follow-up and three or more prothrombin time international normalized ratio (INR) values spread over 6 months. Data collected included demographic, clinical, and radiologic parameters, anticoagulation status during the follow-up, complications, and clinical status at the last follow-up.
Results:
We identified 204 patients, and the mean age was 34.4 ± 11.1 years. The majority had a provoked etiology (194, 95.1%) for CVT. After initial anticoagulation with unfractionated heparin, all patients transitioned to acenocoumarol or warfarin and this was maintained for a mean duration of 16.02 ± 11.2 months. Time in therapeutic range of INR 2-3 was only 5.1 ± 11.8 percent days and time spent in an INR of 1-1.5 was 68.7 ± 31.8 percent days. The average INR over 6 months was 1.37 ± 0.33. Duration of follow-up was 18.9 ± 13.25 months, and a good outcome was noted in 183 (89.7%) patients. Complications were seen in 29 (14.2%) patients. Multivariate analysis showed only the CVT grading scale score to be an independent predictor of good outcome.
Conclusions:
Maintenance of an intensive level of anticoagulation may not be required in patients with CVT and may be particularly true when a transient and treatable risk factor is the provoking etiology.
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