Abstract Details

Title Efficacy and Safety of Direct Oral Anticoagulants vs Warfarin for Cerebral Venous Thrombosis: An Updated Systematic Review and Meta-analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 5-010

Objective To compare the safety and efficacy of direct oral anticoagulants (DOACs) versus warfarin for the treatment of Cerebral Venous Thrombosis (CVT).

Background CVT is a rare but highly morbid cause of stroke. While DOACs have emerged as potential alternatives to warfarin, their comparative safety and efficacy in treating CVT require further investigation.

Design/Methods

We systematically searched PubMed, Embase, and Cochrane databases from inception till May 2025 for randomized controlled trials (RCTs) comparing DOACs with warfarin for CVT. Efficacy outcomes were functional independence (mRS 0-2) and recanalization. Safety outcomes included mortality, recurrent venous thromboembolism, and bleeding. Data was pooled using a random-effects model to calculate relative risks (RRs) with 95% CIs, and heterogeneity was assessed with the I² statistic.

Results

The analysis included six RCTs with a total of 428 patients. For efficacy outcomes, there were no statistically significant differences between DOACs and warfarin in achieving any degree of recanalization (RR 0.99, 95% CI 0.92–1.07, I²=8%), complete recanalization (RR 1.08, 95% CI 0.80–1.44, I²=0%), or functional independence (RR 1.00, 95% CI 0.98–1.02, I²=0%). Regarding safety, DOACs were associated with a non-significant trend toward fewer major bleeding events (RR 0.60, 95% CI 0.12–3.00, I²=0%) and intracranial hemorrhages (RR 0.78, 95%CI 0.08–7.71, I²=32%). Rates of all-cause mortality (RR 1.84, 95%CI 0.17–19.36) and recurrent venous thromboembolism (RR 2.78, 95%CI 0.86–8.95, I2=0%) were low and comparable between the groups.

Conclusions DOACs are equally effective as warfarin in the management of CVT with the potential additional advantage of lowering the risk of bleeding. Due to the few studies and small sample size, further larger studies are required to make definitive clinical recommendations. The results contribute to the justification of the use of DOACs as a valid alternative to warfarin, especially with their fixed dosing and lack of requirement for regular monitoring.

Authors/Disclosures
Sarika Mutyala, MBBS PRESENTER	Dr. Mutyala has nothing to disclose.
Apoorva Vedula, MBBS	Miss Vedula has nothing to disclose.
Sai Kumar Reddy Pasya, MD, MBBS	Dr. Pasya has nothing to disclose.
Sai Krishna Vallamchetla, MBBS (Mayo Clinic, Florida)	Mr. Vallamchetla has nothing to disclose.
Ashvath A. Pillai, Student	Mr. Pillai has nothing to disclose.
Aishwarya J, MD	Ms. J has nothing to disclose.
Bala Vignesh Kalyanasundaram	Mr. Kalyanasundaram has nothing to disclose.
Mohammed Qussay Ali Al-Sabbagh, MD (University of Kansas Medical Center)	Dr. Al-Sabbagh has nothing to disclose.
Gary S. Gronseth, MD, FAAN (University of Kansas)	Dr. Gronseth has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Brain & Life. Dr. Gronseth 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 Neurology. Dr. Gronseth has received personal compensation in the range of $0-$499 for serving as a Member/EBM consultant Guideline Development Subcommittee with AAN.

��ɫ��

��ɫ��