Abstract Details

Title Comparison of Unfractionated Heparin and Low Molecular Weight Heparin in Acute Cerebral Venous Thrombosis: A Sub-analysis of the CLOT-VENUS Registry

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-012

Objective To compare unfractionated heparin (UFH) and enoxaparin, and identified predictors of functional recovery and UFH responsiveness in patients in acute cerebral vein thrombosis (CVT).

Background Anticoagulation therapy, primarily with intravenous IV-UFH infusion or subcutaneous low-molecular-weight heparin (LMWH), remains the cornerstone of acute CVT. Although LMWH is generally preferred due to a more favorable profile, UFH continues to be widely used, particularly in critically ill patients and in acute hospital settings where rapid reversal may be required for emergent surgical interventions.

Design/Methods This cross-sectional study included adults with acute CVT treated with UFH or enoxaparin (2004–2024). UFH response was measured via a composite responsiveness index (UFH-CRI) based on partial thromboplastin time (PTT). The primary outcome was 6-month mRS. Secondary outcomes included discharge mRS and mortality. Multivariate regression and IPTW matching were used for analyses.

Results Among 359 patients (median age 40; 68.5% female), 220 (61.3%) received UFH and 139 (38.7%) enoxaparin. Overall, only 64% of PTT values fell within the therapeutic range, and 24.9% received an initial UFH bolus. UFH was associated with worse outcomes at discharge (mRS 3–6: aOR 2.89; mRS 2–6: aOR 1.90, ordinal mRS aOR 1.56) and at 6 months (mRS 3–6: aOR 2.63). Poor recovery was independently linked to UFH-CRI and frequent infusion adjustments. Notably, in the sensitivity analysis limited to UFH patients with ≥50%, ≥67%, and ≥79% therapeutic PTT values, the outcome differences diminished. Age was identified as an independent predictor of UFH responsiveness, and female sex, elevated BMI, as predictors of increased number of changes in UFH infusion rate.

Conclusions In this international, multicenter cohort of patients with acute CVT, treatment with UFH was associated with worse clinical outcomes compared to enoxaparin, largely attributable to suboptimal and inconsistent anticoagulation. However, when UFH achieves consistent therapeutic levels, the outcomes are comparable. Early predictors may help guide individualized anticoagulation strategies.

Authors/Disclosures
Milagros Galecio-Castillo, MD PRESENTER	Dr. Galecio-Castillo has nothing to disclose.
Leonardo Cruz, MD (University of Iowa)	Dr. Cruz has nothing to disclose.
Amir Shaban, MD (University of Iowa)	Dr. Shaban has nothing to disclose.
Vanessa Cano Nigenda (Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez)	Vanessa Cano Nigenda has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Boehringher. Vanessa Cano Nigenda has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZeneca. The institution of Vanessa Cano Nigenda has received research support from AstraZeneca.
Aaron E. Rodriguez-Calienes (University of Iowa Hospitals and Clinics)	Dr. Rodriguez-Calienes has nothing to disclose.
Trent Smith, MD	Dr. Smith has nothing to disclose.
James C. Torner, PhD (University of Iowa)	The institution of Dr. Torner has received research support from NIH.
Nicholas Mohr, MD	The institution of Dr. Mohr has received research support from National Institutes of Health. The institution of Dr. Mohr has received research support from Agenda for Healthcare Research and Quality. The institution of Dr. Mohr has received research support from Patient Centered Outcomes Research Institute. The institution of Dr. Mohr has received research support from Societ of Critical Care Medicine. The institution of Dr. Mohr has received research support from Centers for Disease Control and Prevention. The institution of Dr. Mohr has received research support from Health Resources and Services Administration.
Andres Alberto M. Mercado Pompa, MD	Dr. Mercado Pompa has nothing to disclose.
Nashwa Abdelhakim, Jr., MD (Minia Faculty of Medicine)	Dr. Abdelhakim has nothing to disclose.
Anderson Brito-Alvarado, MD	Dr. Brito-Alvarado has nothing to disclose.
Adrian Pereda Castillo, MD	Dr. Pereda Castillo has nothing to disclose.
Antonio Arauz, MD, PhD (Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez)	Dr. Arauz has nothing to disclose.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.

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