Dural Arteriovenous Fistulae After Cerebral Venous Thrombosis

Abstract

Background and Purpose: This analysis examined the frequency of dural arteriovenous fistulae (dAVF) after cerebral venous thrombosis (CVT) in patients included in a randomized controlled trial comparing dabigatran etexilate with dose-adjusted warfarin (RE-SPECT CVT [A Clinical Trial Comparing Efficacy and Safety of Dabigatran Etexilate With Warfarin in Patients With Cerebral Venous and Dural Sinus Thrombosis]), who had systematic follow-up magnetic resonance (MR) imaging. Methods: RE-SPECT CVT was a Phase 3, prospective, randomized, parallel-group, open-label, multicenter, exploratory trial with blinded end point adjudication. We allocated patients with acute CVT to dabigatran 150 mg twice daily or dose-adjusted warfarin, for 24 weeks and obtained a standardized MR protocol including time-of-flight MR angiography, 3-dimensionalphase-contrast venography, and 3-dimensional contrast-enhanced MR venography at the end of the treatment period. A blinded adjudication committee assessed the presence of dAVF in a predefined substudy of the trial. Results: We analyzed development of dAVF in 112 of 120 randomized patients; 57 allocated to dabigatran and 55 to warfarin. For 3 (2.7%) of these 112 patients, quality of follow-up imaging was insufficient to evaluate dAVF. A dAVF (Borden I) was found in 1 patient (0.9%) allocated to warfarin; however, this dAVF was already present at baseline. The patient did not present with hemorrhage at baseline or during the trial and was asymptomatic at follow-up. Conclusions: Despite systematic imaging, we found no new dAVF 6 months after CVT. Routine follow-up cerebral MR angiography aiming to detect new dAVF 6 months after CVT has a very low yield. REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT02913326.

Dural arteriovenous fistulas in cerebral venous thrombosis

“…The prevalence of dAVF in the present cohort was higher than most previous reports among CVT patients [3–5]. One recent exploratory study investigated 30 CVT patients with four‐dimensional magnetic resonance venography and detected dAVF in four patients within 6 months, but the investigated number of patients was low [6].…”

“…Cerebral venous thrombosis (CVT) is a rare disease with an incidence of 1.3–1.6 per 100,000 adults, mainly affecting working‐aged individuals and predominantly females [1–3]. The occurrence of dural arteriovenous fistulas (dAVFs) has been reported among 0.9%–13% of patients up to 6 months after diagnosis of CVT, but data are lacking from large cohorts [3–6]. It has been suggested that thrombi in the cerebral venous system may stagnate blood flow, increase venous pressure and thereby cause enlargement of preexisting physiological arteriovenous shunts or stimulation of neoangiogenesis and development of a dAVF [7–11].…”

Direct oral anticoagulants in treatment of cerebral venous thrombosis: a systematic review

“…37 A post hoc analysis of the RE-SPECT CVT showed no DAVF formation at 6 months. 64 Two case studies of edoxaban treated patients with CVT in the context of COVID-19. 45 46 Thrombotic complications of COVID-19 has been reported, but the safety and efficacy of DOAC in COVID-19 related thrombosis specifically has yet to be confirmed.…”

Brain Dural Arteriovenous Fistulas in the Covid-19 era: a warning and rationale for association

“…Except for two cases that suffered COVID-19 infection prior to the vaccine and to the diagnosis of bDAVF, the remaining cases received their rst dose 90 to 200 days before the diagnosis. If a prothrombotic phenomenon is suspected as a potential mechanism for vaccines or COVID to lead to the occurrence of bDAVFs, it is important to note that it has been reported that the incidence of bDAVF signi cantly increases during the rst 6 months following CVT 4,17 . For COVID-19 infections, the time frame in our cohort was 60-80 days.…”