Direct Oral Anticoagulants Versus Warfarin in the Treatment of Cerebral Venous Thrombosis (ACTION-CVT): A Multicenter International Study.

Autor:	Yaghi S; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., Shu L; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., Bakradze E; Department of Neurology, University of Alabama at Birmingham (E.B.)., Salehi Omran S; Department of Neurology, University of Colorado School of Medicine, Aurora (S.S.O.)., Giles JA; Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.)., Amar JY; Department of Neurology, Washington University, Saint Louis, MO (J.A.G., J.Y.A.)., Henninger N; Department of Neurology (N.H., M.E.), University of Massachusetts, Worcester.; Department of Psychiatry (N.H.), University of Massachusetts, Worcester., Elnazeir M; Department of Neurology (N.H., M.E.), University of Massachusetts, Worcester., Liberman AL; Department of Neurology, Weill Cornell Medical Center, NY (A.L.L.)., Moncrieffe K; Department of Neurology, Montefiore Medical Center, NY (K.M., J.L.)., Lu J; Department of Neurology, Montefiore Medical Center, NY (K.M., J.L.)., Sharma R; Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)., Cheng Y; Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)., Zubair AS; Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)., Simpkins AN; Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)., Li GT; Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)., Kung JC; Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)., Perez D; Department of Neurology, University of Florida, Gainesville (A.N.S., G.T.L., J.C.K., D.P.)., Heldner M; Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)., Scutelnic A; Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)., Seiffge D; Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)., Siepen B; Department of Neurology, Inselspital Universitätsspital, Bern, Switzerland (M.H., A.S., D.S., B.S.)., Rothstein A; Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)., Khazaal O; Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)., Do D; Department of Neurology, University of Pennsylvania, Philadelphia, PA (A.R., O.K., D.D.)., Kasab SA; Department of Neurology (S.A.K., L.A.R.), Medical University of South Carolina, Charleston.; Department of Neurosurgery (S.A.K.), Medical University of South Carolina, Charleston., Rahman LA; Department of Neurology (S.A.K., L.A.R.), Medical University of South Carolina, Charleston., Mistry EA; Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)., Kerrigan D; Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.)., Lafever H; Department of Neurology, Vanderbilt University, Nashville, TN (D.K., H.L.)., Nguyen TN; Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)., Klein P; Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.).; Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)., Aparicio H; Department of Neurology, Boston University School of Medicine, MA (T.N.N., P.K., H.A.)., Frontera J; Department of Neurology, New York University, NY (J.F., L.K., S.A.)., Kuohn L; Department of Neurology, New York University, NY (J.F., L.K., S.A.)., Agarwal S; Department of Neurology, New York University, NY (J.F., L.K., S.A.)., Stretz C; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., Kala N; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., El Jamal S; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., Chang A; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., Cutting S; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.)., Xiao H; Department of Biostatistics, University of California Santa Barbara (H.X.)., de Havenon A; Department of Neurology, Yale University, New Haven, CT (R.S., Y.C., A.S.Z., A.d.H.)., Muddasani V; Department of Neurology, University of Utah, Salt Lake City (V.M.)., Wu T; Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.)., Wilson D; Department of Neurology, Christchurch hospital, New Zealand (T.W., D.W.)., Nouh A; Department of Neurology, Hartford Hospital, CT (A.N., S.D.A.)., Asad SD; Department of Neurology, Hartford Hospital, CT (A.N., S.D.A.)., Qureshi A; Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.)., Moore J; Department of Neurology, University of Kansas, Kansas City (A.Q., J.M.)., Khatri P, Aziz Y; Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)., Casteigne B; Department of Neurology and Rehabilitation Medicine, University of Cincinnati (E.A.M., P.K., Y.A., B.C.)., Khan M; Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.)., Cheng Y; Department of Neurology, Spectrum Health, Michigan State University, Grand Rapids (M.K., Y.C.)., Mac Grory B; Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)., Weiss M; Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)., Ryan D; Department of Neurology, Duke University, Durham, NC (B.M.G., M.W., D.R.)., Vedovati MC; Department of Medicine and Surgery, University of Perugia, Italy (M.C.V.)., Paciaroni M; Neurology - Stroke Unit, IRCCS MultiMedica, Milano, Italy (M.P.)., Siegler JE; Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)., Kamen S; Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)., Yu S; Department of Neurology, Cooper University, Camden, NJ (J.E.S., S.K., S.Y.)., Leon Guerrero CR; Department of Neurology, George Washington University, District of Columbia (C.R.L.G., E.A.)., Atallah E; Department of Neurology, George Washington University, District of Columbia (C.R.L.G., E.A.)., De Marchis GM; Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.)., Brehm A; Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.)., Dittrich T; Department of Neurology, University Hospital Basel and University of Basel, Switzerland (G.M.D.M., T.D.)., Psychogios M; Department of interventional and diagnostic Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland (A.B., M.P.)., Alvarado-Dyer R; Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)., Kass-Hout T; Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)., Prabhakaran S; Department of Neurology, University of Chicago, IL (R.A.-D., T.K.-H., S.P.)., Honda T; Department of Neurology, University of California at Los Angeles (T.H., D.S.L.)., Liebeskind DS; Department of Neurology, University of California at Los Angeles (T.H., D.S.L.)., Furie K; Department of Neurology, Brown University, Providence, RI (S.Y., L.S., C.S., N.K., S.E.J., A.C., S.C., K.F.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2022 Mar; Vol. 53 (3), pp. 728-738. Date of Electronic Publication: 2022 Feb 10.
DOI:	10.1161/STROKEAHA.121.037541
Abstrakt:	Background: A small randomized controlled trial suggested that dabigatran may be as effective as warfarin in the treatment of cerebral venous thrombosis (CVT). We aimed to compare direct oral anticoagulants (DOACs) to warfarin in a real-world CVT cohort. Methods: This multicenter international retrospective study (United States, Europe, New Zealand) included consecutive patients with CVT treated with oral anticoagulation from January 2015 to December 2020. We abstracted demographics and CVT risk factors, hypercoagulable labs, baseline imaging data, and clinical and radiological outcomes from medical records. We used adjusted inverse probability of treatment weighted Cox-regression models to compare recurrent cerebral or systemic venous thrombosis, death, and major hemorrhage in patients treated with warfarin versus DOACs. We performed adjusted inverse probability of treatment weighted logistic regression to compare recanalization rates on follow-up imaging across the 2 treatments groups. Results: Among 1025 CVT patients across 27 centers, 845 patients met our inclusion criteria. Mean age was 44.8 years, 64.7% were women; 33.0% received DOAC only, 51.8% received warfarin only, and 15.1% received both treatments at different times. During a median follow-up of 345 (interquartile range, 140-720) days, there were 5.68 recurrent venous thrombosis, 3.77 major hemorrhages, and 1.84 deaths per 100 patient-years. Among 525 patients who met recanalization analysis inclusion criteria, 36.6% had complete, 48.2% had partial, and 15.2% had no recanalization. When compared with warfarin, DOAC treatment was associated with similar risk of recurrent venous thrombosis (aHR, 0.94 [95% CI, 0.51-1.73]; P =0.84), death (aHR, 0.78 [95% CI, 0.22-2.76]; P =0.70), and rate of partial/complete recanalization (aOR, 0.92 [95% CI, 0.48-1.73]; P =0.79), but a lower risk of major hemorrhage (aHR, 0.35 [95% CI, 0.15-0.82]; P =0.02). Conclusions: In patients with CVT, treatment with DOACs was associated with similar clinical and radiographic outcomes and favorable safety profile when compared with warfarin treatment. Our findings need confirmation by large prospective or randomized studies.
Databáze:	MEDLINE
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