Use of oral rivaroxaban in cerebral venous thrombosis

Abstract

Background Cerebral venous thrombosis (CVT) is an uncommon cause of stroke in humans and the mainstay of treatment is anticoagulation unless contraindicated. Non-vitamin K oral anticoagulants have not been duly evaluated in randomized controlled trials in CVT. Objective To compare the efficacy and safety of oral rivaroxaban with vitamin K anticoagulant (warfarin) in preventing recurrent venous thromboembolism (VTE) in patients with CVT. Methods Adult patients with CVT, who were stable after 5–12 days of treatment with parenteral heparin 1 mg/kg, were screened for eligibility. The patients were randomly divided into two groups to receive oral rivaroxaban 20–30 mg daily or warfarin 1, 3 or 5 mg daily (with the dose adjusted to maintain an INR of 2–3), for 3–12 months. Recanalization rates, periprocedural complications, and clinical outcomes were assessed by Magnetic Resonance Venography (MRV) and National Institutes of Health Stroke Scale (NIHSS) at 3rd, 6th and 12th month follow-ups. Results In total, 45 patients with CVT were randomized to the two treatment groups (21 to rivaroxaban and 24 to warfarin). Overall recanalization was achieved by 18 (86%) and 20 (83%) cases from rivaroxaban and warfarin group, respectively at 6th month follow-up; and by all 45 (100%) cases from the both groups at 12th month follow-up. Excellent outcome (NIHSS score 0) was obtained by 20 (95%) cases from rivaroxaban group at 3rd to 12th month follow-ups; and by 23 (96%) cases at 6th to 12th month follow-ups. There were no major bleeding events during the trial. None of the patients developed recurrence of thrombosis. Statistically, no significant difference between the two treatment groups in terms of recanalization and clinical outcomes could be observed. Conclusion Rivaroxaban is a safe option in CVT however; larger randomized controlled studies will impact the results validity.

Safety and efficacy of Direct Oral Anticoagulants in cerebral venous thrombosis: A meta‐analysis

“…The included studies were published from 2014 to 2021, consisting of two randomized controlled trials, 7,8 four prospective studies, [10][11][12][13] and eleven retrospective studies [14][15][16][17][18][19][20][21][22][23][24] . Four studies were from the USA, 17,20,23,24 three from Pakistan, 10,11,18 two from Germany, 16,19 and one study was from Iran, 15 Poland, 12 Portugal, 22 France, 21 and Italy 14 respectively. There were three multicenter studies conducted at different countries.…”

Effect of Rivaroxaban in Stroke Prevention in Patient with Atrial Fibrillation due to Valvular Heart Disease

“…et al found no difference in terms of efficacy between rivaroxaban and warfarin to cause recanalization following cerebral venous sinus thrombosis. 22 Limitation: No doubt this is a medium sized study, the result cannot be generalized to such patients at large in clinical practice. Further research with bigger sample size of such patients with more prolonged follow-up is required in this regard.…”

Role of Rivaroxaban in Patients with Cerebral Venous Thrombosis

“…Maqsood et al studied the same in 45 patients with 21 in Rivaroxaban and 24 in the warfarin group. 17 They documented recanalization in 86% of cases of the Rivaroxaban group and 83% warfarin group at 6 months and 100% at 12 months. NIHSS (National Institute of Health Stroke Scale) score of 0 was obtained in 95% of Rivaroxaban group at follow up on 3 rd to 12 th month.…”