Efficacy and safety of Apixaban in the treatment of cerebral venous sinus thrombosis: a multi-center study

BackgroundInformation regarding the safety and efficacy of specific direct oral anticoagulants (DOAC) in the treatment of cerebral sinus and venous thrombosis (CSVT) is scarce. Apixaban is one of the most frequently prescribed DOACs. Therefore, we aimed to compare the safety and efficacy of Apixaban with those of vitamin k antagonists (VKA) in patients with CSVT.MethodsProspective CSVT databases from seven academic medical centers were retrospectively analyzed. Patients treated with Apixaban were compared to those treated with VKA. Data on demographics, clinical presentations, risk factors, radiological and outcome parameters were studied.ResultsOverall, 403 patients were included in the analysis. Of them, 48 (12%) were treated with Apixaban, and 355 (88%) were treated with VKA. Rates of coagulopathies were significantly higher in the VKA-treated patients but no other differences between the groups were found in baseline characteristics and underlying etiology. No significant differences were found between groups in efficacy or safety parameters including the rates of recanalization, favorable outcomes, one-year mortality, seizures, intracranial hemorrhage or CSVT recurrences.ConclusionOur data suggests that Apixaban may be safe and effective for patients with CSVT. These results should be tested in prospective randomized clinical studies

Characteristics of Multiple Acute Concomitant Cerebral Infarcts Involving Different Arterial Territories

(1) Background: Multiple acute concomitant cerebral infarcts (MACCI) are relatively uncommon. Data regarding the characteristics and outcomes of patients with MACCI are lacking. We, therefore, aimed to characterize the clinical features of MACCI. (2) Methods: Patients with MACCI were identified from a prospective registry of stroke patients admitted to a tertiary teaching center. Patients with an acute single embolic stroke (ASES) involving only one vascular bed served as controls. (3) Results: MACCI was diagnosed in 103 patients who were compared to 150 patients with ASES. MACCI patients were significantly older (p = 0.010), more often had a history of diabetes (p = 0.011) and had lower rates of ischemic heart disease (p = 0.022). On admission, MACCI patients had significantly higher rates of focal signs (p < 0.001), an altered mental state (p < 0.001) and seizures (p = 0.036). The favorable functional outcome was significantly less common in patients with MACCI (p = 0.006). In the multivariable analysis, MACCI was associated with lower chances of achieving favorable outcomes (odds ratio: 0.190, 95% CI: 0.070–0.502). (4) Conclusions: There are important differences in clinical presentation, comorbidities and outcomes between MACCI and ASES. MACCI is less often associated with favorable outcomes and could represent a more severe form of a stroke compared with a single embolic stroke

Predictors of acute symptomatic seizure in cerebral venous thrombosis patients—a multicenter cohort study

Background: Acute symptomatic seizures (ASYS) is a common presentation in cerebral sinus venous thrombosis (CSVT) patients. Objectives: We aimed to characterize CSVT patients experiencing ASYS within 7 days from presentation. Additionaly, we aimed to find predictors for ASYS within CSVT patients. Methods: Prospective CSVT databases from six academic centers (January 2010–December 2023) were retrospectively analyzed. Clinical outcomes at the 90-day follow-up included seizure occurrence and the modified-Rankin-Scale (mRS). Results: From 529 included patients (mean age 42.4 ± 18.6 years, 64.3% females), 106 (20%) had ASYS. ASYS patients were more often males (47.2% vs 20.1%, <0.001), and presented more often with focal neurological deficits (50% vs 22%, p  < 0.001) but less often with papilledema (13.2% vs 29.3%, p  < 0.001). On multivariate analysis cortical-vein thrombosis (odds ratio (OR) 4.17, p  < 0.001), intracerebral hemorrhage (ICH; OR 3.06, p  = 0.002), any superior-sagittal-sinus (SSS) thrombosis (OR 2.49, p  = 0.006), predicted ASYS. Conversely, presentation with papilledema (OR 0.39, p  = 0.03) negatively predicted ASYS. ASYS patients had lower rates of 90-day-mRS-0-1 (51.9% vs 83.9%, p  < 0.001). Patients who experienced seizures between the second and seventh day (n = 58) had similar baseline characteristics to those with seizures only on the day of presentation (n = 48) but were less likely to achieve a good functional outcome by day 90 (42.6% vs 58.9%, p  < 0.05) and had a lower rate of complete recanalization on follow-up venous imaging (25.5% vs 57.5%, p  = 0.02). Status-epilepticus in comparison to non-ASYS patients achieved lower rates of 90-day-mRS-0-1 (11% vs 84%, p  < 0.001) and higher 90-day-mortality (44% vs 5.6%, p  < 0.001). In a multivariate analysis ASYS was a negative predictor for 90-day-mRS-0-1 (OR 3.3, 95% confidence interval 1.43–7.5, p  = 0.005). Conclusion: CSVT patients experiencing ASYS, and to a greater degree patients with either status epilepticus or ASYS between second and seventh day achieved less often 90-day-mRS-0-1. Possibly, they epitomize a different course of disease that may require a more suitable treatment strategy

Prognosis and Outcome of Cerebral Sinus Venous Thrombosis—A Multicenter Cohort Study

Objectives. Cerebral sinus venous thrombosis (CSVT) is a rare stroke subtype and data regarding prognostic factors to predict outcomes are lacking. Thus, we aimed to identify predictors for outcome among CSVT patients. Materials and Methods. Prospective CSVT databases from four academic medical centers were retrospectively studied. Demographics, clinical presentations, risk factors, radiological, and outcome parameters were compared. Results. Out of 508 patients diagnosed with CSVT, 21 patients (4%) died, and 91 (18.6%) had unfavorable outcome ( mRS ≥ 2 ). Age (55.0 vs. 38.5, p &lt; 0.001 ), hypertension (26% vs. 6%, p &lt; 0.001 ), hyperlipidemia (23% vs. 6%, p &lt; 0.001 ), diabetes (17% vs. 4%, p &lt; 0.001 ), malignancy (35% vs. 11%, p &lt; 0.001 ), absence of headache (51% vs. 78%, p &lt; 0.001 ), focal neurological deficit (54% vs. 19%, p &lt; 0.001 ), and ICH (28% vs. 13%, p &lt; 0.001 ) were all associated with unfavorable outcome. After multivariate analysis malignancy (OR 4.2, p = 0.003 ), the presence of focal neurological deficit (OR 5.2, p &lt; 0.001 ) and the presence of headache upon presentation (OR 0.334, p = 0.018 ) remained significant predictors for favorable outcome. Conclusions. Among CSVT patients, malignancy, focal neurological deficits, and absence of headache at presentation were associated with unfavorable outcomes.</jats:p