Abstract TP189: Diagnosis and Treatment Trends of Cerebral Venous Thrombosis in a Large Observational Cohort

Abstract

Background: Cerebral Venous Thrombosis (CVT) is an increasingly recognized etiology of a wide array of neurological presentations ranging from headache to coma with limited treatment options. Here, we review population-level trends in the diagnosis, treatment and outcomes of CVT. Methods: Using administrative data on all discharges from hospitals in New York (2005-2014) and Florida (2005-2015), we identified patients with CVT. Patients with trauma and pyogenic CVT were excluded. Primary outcomes included hospital length of stay and discharge disposition. Linear and logistic regressions were adjusted for age, sex, year of treatment, and hypercoagulability. Results are provided as median [IQR], mean ± SD and OR [95% CI]. Results: Among 1876 patients diagnosed with CVT, median age was 59 [42 - 73] and 60% were female. 61% of the cohort was white, 17% African American and 13% Hispanic. Hypertension was present in 53%, diabetes in 21%, 18% smoked and 4% were diagnosed with a hypercoagulable disorder. 230 (12%) of patients presented with intracerebral hemorrhage. Over the 10-year span of the study, the number of patients diagnosed with CVT annually increased (136 vs. 227, 2005 vs. 2014). 81 (4.3%) of patient were treated with endovascular thrombectomy and/or thrombolysis. This proportion increased significantly over the course of the study (1% vs. 5%, 2005 vs. 2014, p<0.05). In adjusted logistic regression, the likelihood of discharge home versus in-hospital mortality/SNF did not change over the course of the study period (p=0.8). In the subset of patients presenting with intracranial hemorrhage, thrombectomy was associated with increased length of stay (eta 2 0.02, p<0.05, adjusted linear regression), but there was no effect on likelihood of discharge home (p=0.5) or in-hospital mortality/discharge to SNF (p=0.4). Conclusions: In this large observational cohort study over 10-years, we identify an increasing frequency of diagnosis of CVT, without notable changes in discharge outcomes. These findings support the need for further targeted therapies for patients with CVT.