Dabigatran etexilate versus warfarin in cerebral venous thrombosis in Chinese patients (CHOICE-CVT): An open-label, randomized controlled trial

Abstract

Background: The efficacy and safety of dabigatran etexilate for Chinese patients with cerebral venous thrombosis (CVT) has not been well established. Methods: CHOICE-CVT was an exploratory, single-center, randomized, open-label study in the National Center for Neurological Disorders involving Chinese patients with CVT aged 18 to 80 years who were randomly assigned (1:1) to either dabigatran etexilate or warfarin. Oral anticoagulants were initiated after 10-15 days of LMWH. The primary efficacy and safety endpoints included the number of patients with recurrent CVT and/or deep venous thrombosis (DVT) and major clinical bleeding within 180 days. Secondary efficacy endpoints included venous recanalization and change in papilledema at day 180. Secondary safety outcomes comprised death, clinical non-major bleeding, and any bleeding. The study was registered with ClinicalTrials.gov under NCT03930940. Results: Between October 2017 and February 2023, a total of 89 patients were enrolled and randomly assigned to receive either dabigatran etexilate (n=44) or warfarin (n=45). At day 180, the dabigatran etexilate group showed a statistically non-significant but likely clinically significant number of patients with recurrent CVT and/or DVT (8 [18.2%; 95%CI, 6.3-30.0] vs 3 [6.7%; 95%CI, 0.0-14.2], P=0.099, with a power [1-β] of 38.401%) compared to the warfarin group. The dabigatran etexilate group showed a comparable number of patients with clinical major bleeding (0 [0] vs 0 [0], P=1.000), and clinical non-major bleeding (1 [2.3%; 95%CI, 0.0-6.9] vs 1 [2.2%; 95%CI, 0.0-6.7]) but demonstrated a lower risk of any bleeding (1 [2.3%; 95%CI, 0.0-6.9] vs 9 [20.0%; 95%CI, 7.8-32.2]) compared to the warfarin group. Most patients in both groups achieved venous recanalization according to the Modified Qureshi scale (27 [75%; 95%CI, 60.1-89.9] in the dabigatran etexilate group versus 34 [82.9%; 95%CI, 70.9-95.0] in the warfarin group) and exhibited improvement in papilledema as per the Frisén classification (35 [97.2%; 95%CI, 91.6-100.0] in dabigatran etexilate group vs. 37 [88.1%, 95%CI, 77.9-98.3] in warfarin group). Conclusions: These findings regarding efficacy and safety support the consideration of dabigatran etexilate therapy as a viable treatment option for Chinese patients with CVT.