Novel Factor Xa Inhibitor for the Treatment of Cerebral Venous and Sinus Thrombosis: First Experience in 7 Patients

• Published in: Stroke (1970) 2014-08, Vol.45 (8), p.2469-2471
• Main Authors: Geisbüsch, Christina, Richter, Daniel, Herweh, Christian, Ringleb, Peter A, Nagel, Simon
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Anticoagulants - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Factor Xa Inhibitors; Female; Humans; Male; Medical sciences; Middle Aged; Morpholines - therapeutic use; Neurology; Pharmacology. Drug treatments; Phenprocoumon - therapeutic use; Rivaroxaban; Sinus Thrombosis, Intracranial - drug therapy; Thiophenes - therapeutic use; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Vasodilator agents. Cerebral vasodilators; Venous Thrombosis - drug therapy; Young Adult
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.114.006167

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 groupsphenprocoumon (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.