Cerebral venous thrombosis in Argentina: clinical presentation, predisposing factors, outcomes and  literature review.

Autor: Alet M; Centro Integral de Neurología Vascular, FLENI. Ciudad Autónoma de Buenos Aires, Argentina; Hospital General de Agudos J. M. Ramos Mejía. Ciudad Autónoma Buenos Aires, Argentina. Electronic address: malet@fleni.org.ar., Ciardi C; Clínica La Sagrada Familia. Ciudad Autónoma de Buenos Aires, Argentina., Alemán A; IMAC - Instituto Médico de Alta Complejidad. Salta, Argentina., Bandeo L; Hospital Británico. Ciudad Autónoma de Buenos Aires, Argentina., Bonardo P; Hospital Británico. Ciudad Autónoma de Buenos Aires, Argentina., Cea C; Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires, Argentina., Cirio J; Clínica La Sagrada Familia. Ciudad Autónoma de Buenos Aires, Argentina., Cossio J; Hospital Ángel Cruz Padilla. Tucumán, Argentina., Cuculic M; Hospital Julio Cecilio Perrando. Chaco, Argentina., Esnaola MM; Hospital César Milstein. Ciudad Autónoma de Buenos Aires, Argentina., García-Pérez F; Neuromadryn. Chubut, Argentina., Giner F; Hospital Lagomaggiore. Mendoza, Argentina., Gómez-Schneider M; Instituto de Neurología y Neurocirugía. Sanatorio de los Arcos. Ciudad Autónoma de Buenos Aires, Argentina., Isaac C; Hospital Dr. Arturo Oñativia. Buenos Aires, Argentina., Lepera S; Hospital General de Agudos J. M. Ramos Mejía. Ciudad Autónoma Buenos Aires, Argentina., Martínez C; Hospital Cullen. Santa Fe, Argentina., Martínez-Lorenzín R; Hospital Provincial del Centenario. Santa Fe, Argentina., Montes M; HIGA Gral. San Martín de La Plata. Buenos Aires, Argentina., Orzuza G; Hospital San Bernardo. Salta, Argentina., Persi G; Sanatorio de la Trinidad Mitre. Ciudad Autónoma de Buenos Aires, Argentina., Povedano G; Complejo Médico Policial Churruca-Visca. Ciudad Autónoma de Buenos Aires, Argentina., Pujol-Lereis V; Centro Integral de Neurología Vascular, FLENI. Ciudad Autónoma de Buenos Aires, Argentina., Quiroga-Narváez J; Hospital Dr. Guillermo Rawson. San Juan, Argentina., Romano M; CEMIC. Ciudad Autónoma de Buenos Aires, Argentina., Sabio R; Hospital SAMIC de Alta Complejidad Gobernador Cepernic - Presidente Kirchner. Santa Cruz, Argentina., Viglione J; Clínica Regional del Sud. Córdoba, Argentina., Zurrú MC; Hospital Italiano de Buenos Aires. Ciudad Autónoma de Buenos Aires, Argentina., Saposnik G; Stroke Outcomes and Decision Neuroscience Research Unit, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada.
Jazyk: angličtina
Zdroj: Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association [J Stroke Cerebrovasc Dis] 2020 Oct; Vol. 29 (10), pp. 105145. Date of Electronic Publication: 2020 Jul 28.
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105145
Abstrakt: Background: Cerebral venous thrombosis (CVT) is a rare medical condition that primarily affects young adults. The clinical spectrum is broad and its recognition remains a challenge for clinicians. Limited information is available on CVT in Argentina. Our goal was to report the results of the first National registry on CVT in Argentina and to compare clinical presentation, predisposing factors and outcomes with other international registries.
Material and Method: The Argentinian National Registry on CVT (ANR-CVT) is a multicenter retrospective cohort study comprising patients aged 18 and older with a diagnosis of CVT from January 2015 to January 2019. We evaluated demographics, predisposing factors, clinical presentation, and radiological characteristics (e.g. number of involved sinuses, venous infarction or hemorrhage on CT and MRI scans at admission), therapeutic interventions and functional outcomes at discharge and at 90 days. Our results were compared to a literature review of CVT registries.
Results: Overall, one hundred and sixty-two patients met the inclusion criteria. The mean age was 42 (±17) years; 72% were women. Seventy percent of patients were younger than 50 years. The most common presenting symptom was headache (82%). The transverse sinus was the most common site of thrombosis (70%) followed by the sigmoid sinus (46%). The main predisposing factor in women was contraceptive use (44%), 3% of the events occurred during pregnancy and 9% during the puerperium. Participants 50 years and older had a higher frequency on malignancy related (7.5% vs. 30%, p = 0.0001) and infections (2% vs. 11%, p = 0.001). The modified Rankin Scale (mRS) ≤2 at discharge was 81% and the rate of mortality at discharge was 4%. At 90 days, the mRS≤2 was 93%. When the ANR-CVT was compared with larger registries from Europe and Asia, the prevalence of cancer among patients with CVT was two to five-fold higher (15% vs. 7% and 3%, respectively; p = 0.002 and p < 0.001). Anticoagulation rates at discharge were also higher (94%) compared to registries from Asia (ASCVT - 68%) or Turkey (VENOST - 67%).
Conclusion: Participants in the first ANR-CVT had a low mortality and disability at 90 days. Clinical and radiological characteristics were similar to CVT from other international registries with a higher prevalence of cancer. There was a high variability in treatment adherence to guidelines as reflected by anticoagulation rates (range 54.5%-100%) at discharge.
Competing Interests: Declaration of Competing Interest All authors certify that they have no affiliations with or involvement in any organization or entity with any financial or nonfinancial interest in the subject matter or materials discussed in this manuscript.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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