Thrombolysis or anticoagulation for cerebral venous thrombosis (TO-ACT trial)

Coutinho, Jonathan M.; Ferro, Jayme; Zuurbier, Susanna M.; Canhão, Patrı́cia; Majoie, Charles B. L. M.; Reekers, Jim A.; Houdart, Emmanuel; Haan, Rob J. de; Bousser, Marie‐Germaine; Stam, Jan

doi:10.1016/j.jns.2013.07.935

Cited by 5 publications

(5 citation statements)

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“…The trial was stopped early for futility after enrolling 63 out of the planned 164 subjects (due to slow recruitment). No difference was found in rates of the primary endpoint between the endovascular versus standard treatment groups—a good outcome (mRS 0–2) was achieved at 12 months in 65 versus 66% of patients 45 , 46 .…”

Section: Discussionmentioning

confidence: 88%

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

Krajíčková

Král

Herzig

et al. 2020

Sci Rep

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We aimed was to assess the factors influencing therapy choice and clinical outcome after 3–4 months in patients with cerebral venous sinus thrombosis (CVST). In a retrospective, bi-centric study, the set consisted of 82 consecutive CVST patients (61 females; mean age 33.5 ± 15.7 years). Following data were collected: baseline characteristics, presence of gender-specific risk factors (GSRF), location and extent of venous sinus impairment, clinical presentation, type of treatment, recanalization, presence of parenchymal lesions, and clinical outcome after 3–4 months (assessed using the modified Rankin Scale [mRS], with excellent outcome defined as mRS 0–1). Multivariate logistic regression analysis was used for statistical evaluation. After 3–4 months, complete recovery was achieved in 41 (50%) and excellent clinical outcome in 67 (81.7%) patients. Female sex (OR 0.11; p = 0.0189) and presence of focal neurologic deficit (OR 0.16; p = 0.0165) were identified as significant independent negative predictors and, the presence of GSRF (OR 15.63; p = 0.0011) as significant independent positive predictor of excellent clinical outcome. In conclusion, in our CVST patients, the presence of GSRF was associated with excellent clinical outcome, while the female sex itself was associated with poorer clinical outcome.

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Section: Discussionmentioning

confidence: 88%

Factors influencing therapy choice and clinical outcome in cerebral venous sinus thrombosis

Krajíčková

Král

Herzig

et al. 2020

Sci Rep

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“…23 Local thrombolysis was compared with heparin treatment in the TO-ACT trial (registered at www.clinicaltrials.gov as #NCT01204333), which was prematurely interrupted because of futility (no difference in the primary outcome disability) after the inclusion of 67 patients. 24,25 A systematic review of 26 patients treated with systemic thrombolysis (mainly urokinase) reported an extracranial or intracranial hemorrhage in 30.7% of patients and partial or complete recanalization in 61.5%. 26 Hence, local or systemic thrombolysis should be reserved for patients with severe cases or those with worsening neurological symptoms despite therapeutic anticoagulation.…”

Section: Cvstmentioning

confidence: 99%

Treatment of unusual thrombotic manifestations

Abbattista¹,

Capecchi

Martinelli

2020

Blood

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Venous thrombosis rarely occurs at unusual sites such as cerebral, splanchnic, upper-extremity, renal, ovarian, or retinal veins. Clinical features, symptoms, and risk factors of rare thrombotic manifestations are heterogeneous and in large part differ from those typical of the commonest manifestations of venous thrombosis at the lower extremities. The therapeutic approach also varies widely according to the affected site, whether cerebral, abdominal, or extraabdominal. To date, anticoagulant therapy for thrombosis at unusual sites is generally accepted, but the optimal therapeutic approach remains challenging. This review is focused on the treatment of unusual thrombotic manifestations as reported in the most recent guidelines and according to the updated scientific literature.

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“…Our study reports 4 different outcomes for ET compared with AC, which suggest the necessity of prudent clinical decisions on current ET. In the randomized controlled trial TO-ACT (NCT01204333), 6 the primary outcome (mRS ≤ 1 at 12 mo) was not achieved in 63 included severe CVST patients. Part of results were announced at the third European Stroke Organisation Conference that 4 of 31 died in ET group while 1 died of 32 in standard treatment, which indicates a tendency of higher mortality in ET group.…”

Section: Discussionmentioning

confidence: 99%

“…3 Endovascular therapy (ET) is another major treatment that is highly anticipated 4 and it is considered a candidate treatment for some severe patients by US Guidelines. 5 Unexpectedly, a randomized controlled trial called thrombolysis or anticoagulation for cerebral venous thrombosis 6 designed to compare 2 treatments has been prematurely terminated. Data shows no difference detected in primary outcome [modified Rankin Scale (mRS) ≤ 1 at 12 mo] in 63 patients, but 4 versus 1 deaths between endovascular treatment and AC.…”

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confidence: 99%