Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis
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Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis Grace K. H. Lee1 · Vanessa H. Chen1 · Choon‑Han Tan2 · Aloysius S. T. Leow1 · Wan‑Yee Kong3 · Ching‑Hui Sia1,4 · Nicholas W. S. Chew1 · Tian‑Ming Tu5 · Bernard P. L. Chan6 · Leonard L. L. Yeo1,6 · Vijay K. Sharma1,6 · Benjamin Y. Q. Tan1,6
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Cerebral venous thrombosis (CVT) causes significant disability and mortality. Current guidelines for CVT management support the initial use of unfractionated heparin or low molecular weight heparin followed by longer-term oral vitamin K antagonist (VKA). There has been increasing, albeit limited, evidence for the use of direct oral anticoagulants (DOAC) as an alternative to VKA. We performed a systematic review and meta-analysis of studies that compared the safety and efficacy of DOACs to VKA in treating CVT. A comprehensive literature search was carried out in Medline, Embase and Cochrane Stroke Group Trials Register using a suitable keyword/MeSH term search strategy. All studies published in English comparing outcomes of patients with CVT treated with DOAC or VKA were included. In total, 6 studies (5 observational studies and 1 randomized clinical trial) comprising 412 patients (age range 16–83 years) were analyzed. DOAC was used in 151 patients, while 261 received VKA. The follow-up period was 3–11 months. The efficacy of DOACs was comparable with VKA in terms of partial or full thrombus recanalization (RR 1.02, 95% CI 0.89–1.16) and excellent functional recovery with modified Rankin scale 50% and I2 > 75% were considered to reflect substantial and considerable heterogeneity, respectively. No subgroup analyses were done in our study. All statistical analyses were conducted with the Review Manager (RevMan) Version 5.3 software (Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration 2014).
Data availability statement All data used for analyses are available within the manuscript and the original publications of included studies.
Results Literature search The electronic search strategy yielded 2410 records, of which 2354 were excluded either due to duplicates or deemed off-topic after an initial screen of title and abstract, as the patient population were not those diagnosed with cerebral venous thrombosis and/or DOAC was not used as a treatment arm. A further 58 articles were excluded after full-text review, mainly due to lack of a comparison treatment arm. The study identification and selection process is reflected in Fig. 1 (PRISMA flow chart). Finally, 6 eligible studies were included in our meta-analysis, which comprised 5 observational studies (1 abstract, 4 papers) and 1
randomized clinical trial. The protocol and patient characteristics of the included studies are briefly summarized in Table 1.
Baseline characteristics A total of 412 patients were included, with age range 16 to 83 years, comprising 65.0% female (n = 249/383). DOAC was used in 151 patients (9
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