Abstract Details

Title Novel Oral Anticoagulants (NOACs) vs. Warfarin in the Treatment of Cerebral Venous Sinus Thrombosis (CVST): A retrospective study of functional and radiographic outcomes among patients enrolled in BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) at UVA.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P5 - Poster Session 5 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-012

Objective To assess 6-month outcomes among patients with CVST treated with NOACs, as compared to warfarin.

Background CVST is a rare form of stroke historically treated with warfarin. Since the introduction of NOACs, practice has shifted, favoring their use in the treatment of CVST. There is limited data substantiating the effect and safety of NOACs for this condition.

Design/Methods Forty patients with diagnosis of CVST, 18+ years of age, and willing to provide a biospecimen to a central DNA repository have enrolled in BEAST at UVA since 2012. Patients completing 6 months of clinical and radiographic follow-up, who were treated with NOACs or warfarin upon discharge were included. We grouped patients by treatment and compared rates of favorable functional outcome (mRS=0-1), radiographic recanalization, recurrent thrombosis, and hemorrhagic complications between groups.

Results Twenty-nine patients were included (apixaban=8, rivaroxaban=2, warfarin=19) in the analysis. Overall, 75.9% of patients (n=22/29) had favorable functional outcomes at six months. All patients in the NOAC group (n=10) and 89.5% (n=17/19) in the warfarin group had at least partial recanalization by six months. In the NOAC group, one patient developed a contralateral CVST; no hemorrhagic events occurred within the 6 months of follow up. In the warfarin group, two patients experienced new thrombotic events (CVST = 1, DVT = 1), and three patients experienced major hemorrhage (subdural hematoma =2, menometrorrhagia = 1) during the follow-up period. There were no statistically significant differences in rates of favorable functional outcome, recanalization, recurrent thrombosis or major hemorrhage between groups.

Conclusions Patients treated with NOACs for CVST achieve similar rates of good functional outcome and recanalization as those treated with warfarin. While not statistically significant, higher rates of major hemorrhage in the warfarin group suggest a favorable safety profile of NOACs. Further study to establish the optimal medical management of CVST is warranted.

Authors/Disclosures
Jeremy D. Wells, MD PRESENTER	No disclosure on file
Matthew E. Ehrlich, MD (DUKE UNIVERSITY MEDICAL CENTER)	No disclosure on file
Michelle C. Johansen, MD	Dr. Johansen has received research support from NINDS/NIA. Dr. Johansen has received research support from American Heart Association.
Shareena A. Rahman, MD (Duke Neurology)	Dr. Rahman has nothing to disclose.
Sherita Chapman, MD (University of Virginia)	Dr. Chapman has received personal compensation in the range of $100,000-$499,999 for serving as a Stroke Section Chief with VA Medical Center.
Bradford B. Worrall, MD, MSc, FAAN (University Of Virginia Health System)	The institution of Dr. Worrall has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN. The institution of Dr. Worrall has received research support from NIH. The institution of Dr. Worrall has received research support from AHA/ASA.
Nicole A. Chiota-McCollum, MD, MEd (Penn Medicine Lancaster General Health)	Dr. Chiota-McCollum has nothing to disclose.

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