Novel Factor Xa Inhibitor for the Treatment of Cerebral Venous and Sinus Thrombosis

Abstract

Background and Purpose— Thrombosis of cerebral veins and sinus (cerebral venous thrombosis) is a rare stroke pathogenesis. Pharmaceutical treatment is restricted to heparin and oral anticoagulation with vitamin K antagonists (VKAs). Methods— Between January 2012 and December 2013, we recorded data from our patients with cerebral venous thrombosis. The modified Rankin scale was used to assess clinical severity; excellent outcome was defined as modified Rankin scale 0 to 1. Recanalization was assessed on follow-up MR angiography. Patients were then divided into 2 treatment groups: phenprocoumon (VKA) and a novel factor Xa inhibitor. Clinical and radiological baseline data, outcome, recanalization status, and complications were retrospectively compared. Results— Sixteen patients were included, and 7 were treated with rivaroxaban. Overall outcome was excellent in 93.8%, and all patients showed at least partial recanalization. No statistical significant differences were found between the groups, except the use of heparin before start of oral anticoagulation ( P =0.03). One patient in the VKA and 2 patients in the factor Xa inhibitor group had minor bleeding ( P =0.55) within the median (range) follow-up of 8 months (5–26). Conclusions— Factor Xa inhibitor showed a similar clinical benefit as VKA in the treatment of cerebral venous thrombosis. Further systematic prospective evaluation is warranted.

Treatment of Cerebral Venous Thrombosis with Rivaroxaban

“…Recanalization rates and clinical outcome of our small sample of patients treated with rivaroxabam confirm previous observations [4,5], eventough these studies have retrospective, uncontrolled design and a small sample size, they all showed a similar clinical benefit in addition to NOAC better safety profile.…”

Dabigatran in the Treatment of Extensive Cerebral Venous Thrombosis: A Case Report

“…In about 20% of cases patients did not achieve reperfusion; however, in all instances, this was deemed related to old age or non-modifiable risk factors such as cancer and lupus [7]. The second study evaluated the use of rivaroxaban in the acute treatment of CVT and found no significant recurrences or complications during 8 months of follow-up [8].…”

Successful Treatment of Cerebral Sinus Thrombosis with Edoxaban Alone

“…There have been some case reports of cerebral sinus thrombosis being treated with dabigatran, rivaroxaban or edoxaban [7][8][9][10]. However, none of these case reports were randomized controlled trials.…”