Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand?
Background: Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, constituting 0.5–3% of all strokes with an extremely varied spectrum of presentation, predisposing factors, neuroimaging findings, and eventual outcomes. A high index of suspicion is needed because timely diagnosis can sig...
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2025-01-01
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| author | Nikhil Vojjala Supriya Peshin Lakshmi Prasanna Vaishnavi Kattamuri Rabia Iqbal Adit Dharia Jayalekshmi Jayakumar Rafi Iftekhar Shagun Singh Mamtha Balla Claudia S. Villa Celi Ramya Ramachandran Rishab Prabhu Sumeet K. Yadav Geetha Krishnamoorthy Vijendra Singh Karan Seegobin |
| author_facet | Nikhil Vojjala Supriya Peshin Lakshmi Prasanna Vaishnavi Kattamuri Rabia Iqbal Adit Dharia Jayalekshmi Jayakumar Rafi Iftekhar Shagun Singh Mamtha Balla Claudia S. Villa Celi Ramya Ramachandran Rishab Prabhu Sumeet K. Yadav Geetha Krishnamoorthy Vijendra Singh Karan Seegobin |
| author_sort | Nikhil Vojjala |
| collection | DOAJ |
| description | Background: Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, constituting 0.5–3% of all strokes with an extremely varied spectrum of presentation, predisposing factors, neuroimaging findings, and eventual outcomes. A high index of suspicion is needed because timely diagnosis can significantly alter the natural course of the disease, reduce acute complications, and improve long-term outcomes. Due to its myriad causative factors, protean presentation, and association with several systemic diseases, CVT is encountered not only by neurologists but also by emergency care practitioners, internists, hematologists, obstetricians, and pediatricians. Discussion: Anticoagulation remains the mainstay of treatment for CVT. Heparin and warfarin previously had been the anticoagulation of choice. Recently there has been an increased interest in utilizing direct-acting oral anticoagulants in the treatment of CVT given comparable safety and efficacy with ease of utilization. However recent clinical guidelines given by multiple societies including the American Stroke guidelines and European guidelines do not include these agents so far in their treatment recommendations. Ongoing multicentric clinical trials are currently reviewing the role of these agents in both short-term as well as long-term. Our review of the literature supports the safety and reinforces the efficacy of DOAC in the treatment of CVT. Additionally, patient satisfaction has been shown to be better with the use of DOAC. In conclusion, DOAC continues to have a valid role in the management of CVT. |
| format | Article |
| id | doaj-art-5a6db223f0c841c4b5df3515fb9d63fb |
| institution | Kabale University |
| issn | 2227-9059 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj-art-5a6db223f0c841c4b5df3515fb9d63fb2025-01-24T13:24:20ZengMDPI AGBiomedicines2227-90592025-01-0113118910.3390/biomedicines13010189Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand?Nikhil Vojjala0Supriya Peshin1Lakshmi Prasanna Vaishnavi Kattamuri2Rabia Iqbal3Adit Dharia4Jayalekshmi Jayakumar5Rafi Iftekhar6Shagun Singh7Mamtha Balla8Claudia S. Villa Celi9Ramya Ramachandran10Rishab Prabhu11Sumeet K. Yadav12Geetha Krishnamoorthy13Vijendra Singh14Karan Seegobin15Department of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USADepartment of Internal Medicine, Norton Community Hospital, Norton, VA 24273, USADepartment of Internal Medicine, Tech University Health Sciences Centre, El Paso, TX 79905, USAInternal Medicine, Brooklyn Hospital Center, Brooklyn, NY 11201, USAHCA Florida Oak Hill Hospital, Brooksville, FL 34613, USAInternal Medicine, Brooklyn Hospital Center, Brooklyn, NY 11201, USADepartment of Internal Medicine, Norton Community Hospital, Norton, VA 24273, USADepartment of Internal Medicine, Banner Health, University of Arizona, Tucson, AZ 85719, USAMD Anderson Cancer Center, Department of Infectious Disease Transplant, University of Texas, Houston, TX 77030, USAInternal Medicine, Capital Health, Trenton, NJ 08638, USADepartment of Internal Medicine, Banner Health, University of Arizona, Tucson, AZ 85719, USADepartment of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USADepartment of Hospital Internal Medicine, Mayo Clinic Health System, Mankato, MN 56001, USADepartment of Internal Medicine, Trinity Health Oakland Hospital, Pontiac, MI 48341, USADepartment of Hematology-Oncology, Karmanos Cancer Center, Wayne State University School of Medicine, Detroit, MI 48201, USADepartment of Medical Oncology, Mayo Clinic Health System, Mankato, MN 56001, USABackground: Cerebral venous sinus thrombosis (CVT) is a rare cause of stroke, constituting 0.5–3% of all strokes with an extremely varied spectrum of presentation, predisposing factors, neuroimaging findings, and eventual outcomes. A high index of suspicion is needed because timely diagnosis can significantly alter the natural course of the disease, reduce acute complications, and improve long-term outcomes. Due to its myriad causative factors, protean presentation, and association with several systemic diseases, CVT is encountered not only by neurologists but also by emergency care practitioners, internists, hematologists, obstetricians, and pediatricians. Discussion: Anticoagulation remains the mainstay of treatment for CVT. Heparin and warfarin previously had been the anticoagulation of choice. Recently there has been an increased interest in utilizing direct-acting oral anticoagulants in the treatment of CVT given comparable safety and efficacy with ease of utilization. However recent clinical guidelines given by multiple societies including the American Stroke guidelines and European guidelines do not include these agents so far in their treatment recommendations. Ongoing multicentric clinical trials are currently reviewing the role of these agents in both short-term as well as long-term. Our review of the literature supports the safety and reinforces the efficacy of DOAC in the treatment of CVT. Additionally, patient satisfaction has been shown to be better with the use of DOAC. In conclusion, DOAC continues to have a valid role in the management of CVT.https://www.mdpi.com/2227-9059/13/1/189cerebral venous sinus thrombosisdirect-acting oral anticoagulantssafetyefficacy |
| spellingShingle | Nikhil Vojjala Supriya Peshin Lakshmi Prasanna Vaishnavi Kattamuri Rabia Iqbal Adit Dharia Jayalekshmi Jayakumar Rafi Iftekhar Shagun Singh Mamtha Balla Claudia S. Villa Celi Ramya Ramachandran Rishab Prabhu Sumeet K. Yadav Geetha Krishnamoorthy Vijendra Singh Karan Seegobin Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand? Biomedicines cerebral venous sinus thrombosis direct-acting oral anticoagulants safety efficacy |
| title | Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand? |
| title_full | Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand? |
| title_fullStr | Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand? |
| title_full_unstemmed | Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand? |
| title_short | Direct-Acting Oral Anticoagulants in the Management of Cerebral Venous Sinus Thrombosis—Where Do We Stand? |
| title_sort | direct acting oral anticoagulants in the management of cerebral venous sinus thrombosis where do we stand |
| topic | cerebral venous sinus thrombosis direct-acting oral anticoagulants safety efficacy |
| url | https://www.mdpi.com/2227-9059/13/1/189 |
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