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

Simaan, Naaem; Honig, Asaf; Hallevi, Hen; Seyman, Estelle; Rotschild, Ofer; Assayag, Einor Ben; Filioglo, Andrei; Peretz, Shlomi; Mendel, Rom; Barnea, Rani; Auriel, Eitan; Aladdin, Shorooq; Orion, David; Darawsha, Khalil; Shbat, Fadi; Leker, Ronen R.; Molad, Jeremy

doi:10.1155/2023/8016006

Cited by 4 publications

(2 citation statements)

References 26 publications

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“…Data from the Israeli CSVT study was retrospectively analyzed. This is an ongoing observational study, continuously enrolling adult patients diagnosed with non-traumatic CSVT that were admitted to seven comprehensive stroke centers in Israel ( 18 ). The study was approved by the ethical committees in each of the participating centers.…”

Section: Methodsmentioning

confidence: 99%

“…All imaging studies were interpreted by experienced neuroradiologists and experienced stroke neurologists. The site and location of the occluded venous were recorded as previously described ( 9 , 18 ). Multiple vein/sinus involvement was defined as involvement of more than one site, excluding continuous involvement of the transverse and sigmoid sinuses on the same side or cortical vein involvement.…”

Section: Methodsmentioning

confidence: 99%

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

Simaan,

Metanis,

Honig

et al. 2024

Front. Neurol.

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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.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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

Simaan,

Metanis,

Honig

et al. 2024

Front. Neurol.

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Development and Validation of a Clinical Score to Predict Epilepsy After Cerebral Venous Thrombosis

Lindgren,

Shu,

Simaan

et al. 2024

JAMA Neurol

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ImportanceOne of 10 patients develop epilepsy in the late phase after cerebral venous thrombosis (CVT) diagnosis but predicting the individual risk is difficult.ObjectiveTo develop and externally validate a prognostic score to estimate the individual risk of post-CVT epilepsy.Design, Setting, and ParticipantsThis observational cohort study included both retrospective and prospective patients enrolled from 1994 through 2022. For development of the DIAS3 score, data from the International CVT Consortium (n = 1128), a large international hospital-based multicenter CVT cohort, were used. For validation, data from 2 independent multicenter cohorts, the ACTION-CVT (n = 543) and the Israel CVT study (n = 556), were used. Of 2937 eligible, consecutively enrolled adult patients with radiologically verified CVT, 710 patients with a history of epilepsy prior to CVT, follow-up less than 8 days, and missing late seizure status were excluded.ExposureThe prediction score (DIAS3) was developed based on available literature and clinical plausibility and consisted of 6 readily available clinical variables collected during the acute phase: decompressive hemicraniectomy, intracerebral hemorrhage at presentation, age, seizure(s) in the acute phase (excluding status epilepticus), status epilepticus in the acute phase, and subdural hematoma at presentation.Main Outcome and MeasureTime to a first late seizure, defined as occurring more than 7 days after diagnosis of CVT.ResultsOf 1128 patients included in the derivation cohort (median age, 41 [IQR, 30-53] years; 805 women [71%]), 128 (11%) developed post-CVT epilepsy during a median follow-up of 12 (IQR, 3-26) months. According to the DIAS3 score, the predicted 1-year and 3-year risk of epilepsy in individual patients ranged from 7% to 68% and 10% to 83%, respectively. Internal and external validation showed adequate discrimination in the derivation cohort (1 year and 3 years: C statistic, 0.74; 95% CI, 0.70-0.79) and the 2 independent validation cohorts, (ACTION-CVT) 1 year: C statistic, 0.76; 95% CI, 0.67-0.84; 3 years: C statistic, 0.77; 95% CI, 0.66-0.84; and Israel CVT study 1 year: C statistic, 0.80; 95% CI, 0.75-0.86. Calibration plots indicated adequate agreement between predicted and observed risks.Conclusions and RelevanceThe DIAS3 score (freely available online) is a simple tool that can help predict the risk of post-CVT epilepsy in individual patients. The model can improve opportunities for personalized medicine and may aid in decision-making regarding antiseizure medication, patient counseling, and facilitation of research on epileptogenesis in CVT.

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Sex differences in clinical profile and risk factors of cerebral venous sinus thrombosis at a high-altitude area: A 10-year retrospective cross-sectional study

Zarimeidani,

Rahmati,

Mokary

et al. 2024

Medicine

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Cerebral venous sinus thrombosis (CVST) is an uncommon disorder with an increased mortality risk. Data on the sex-specific clinical profile and related factors can be practical in clinical diagnosis and management. Thus, we aimed to assess CVST characteristics in Shahrekord, the most elevated city among the centers of the provinces of Iran, referred to as the Roof of Iran. In this retrospective cross-sectional study, we reviewed the hospital records of 127 CVST patients between April 2013 and June 2023 to analyze the demographic characteristics, clinical profile, disease outcomes, and risk factors. STROBE guidelines were used to report this study. Females comprised 65.3% of the study. Females’ age was almost equal to male patients (37.51 ± 13.95 years vs 38.09 ± 16.18 years, P = .832), and more than half of the patients (59.1%) were married. Clinical characteristics showed no significant difference between the sexes. In contrast to males, females had multifarious risk factors. However, the main risk factors for both sexes were CVST and hypertension. Most patients had 1 sinus affected (55.9%), and the location of thrombosis was mainly in the right transverse sinus in males (38.63%) and superior sagittal sinus in females (33.73%). However, those with more than 2 affected sinuses were mostly women. Regarding radiological findings, sinusitis was significantly seen in men (18.18% vs 3.61%). Among laboratory data, females significantly had higher erythrocyte sedimentation rate levels than males (21.66 ± 24.39 vs 9.60 ± 8.55). This study indicates that among CVST patients, men have significantly higher occurrences of sinusitis, and higher levels of erythrocyte sedimentation rate were observed in women. However, no other significant differences were found. More extensive studies are essential to fully comprehend the sex-specific aspects of CVST.

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

Cited by 4 publications

References 26 publications

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

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

Development and Validation of a Clinical Score to Predict Epilepsy After Cerebral Venous Thrombosis

Sex differences in clinical profile and risk factors of cerebral venous sinus thrombosis at a high-altitude area: A 10-year retrospective cross-sectional study

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