Specific Features of Cerebral Venous Thrombosis Associated With Iron Deficiency Anemia

Anemia has emerged as a risk factor for cerebral venous thrombosis (CVT) and has been associated with poorer outcomes. A specific association has been observed with microcytic anemia, most commonly caused by iron deficiency anemia (IDA). However, detailed data on the clinical, radiological, and therapeutic profile of CVT in patients with IDA remain limited.

We analyzed consecutive patients with CVT and moderate or severe IDA from the prospective Lariboisière Hospital cohort with CVT (1998-2023). Patients with other types of anemia were excluded. Clinical, neuroimaging, treatment, and outcome data were compared with those of patients with CVT without anemia.

Among 616 patients with CVT, 64 (10.4%) had moderate or severe IDA. Most were women (96.9%), with chronic gynecological bleeding (eg, fibroids, adenomyosis) as the predominant cause. All received anticoagulation. Additional treatments included iron supplementation, blood transfusion, gynecological surgery, and gonadotropin-releasing hormone analogs. Compared with patients without anemia (n=502), those with IDA more frequently presented with focal neurological deficits and parenchymal lesions (54.7% versus 35.3%, P=0.0025), particularly venous infarctions (32.8% versus 14.5%, P=0.0002). Despite more severe initial presentations, 1-year functional outcomes did not significantly differ between groups (adjusted odds ratio for excellent outcome associated with IDA, 0.60 [95% CI, 0.23-1.52]).

IDA is a prevalent comorbidity in CVT, affecting predominantly young women with benign, treatable causes of IDA. Although associated with more severe initial findings, long-term outcomes did not differ from those of patients without IDA. Appropriate recognition and specific management of IDA should be considered in patients with CVT.