Abstract WP95: Combination Of Steroid And Anticoagulant Therapy To Treat Acute/subacute Severe Cerebral Venous Thrombosis

Abstract

Introduction: Endovascular treatment combined with standard anticoagulant treatment often fails to improve functional outcomes of patients with severe cerebral venous thrombosis (CVT). Accumulating evidence suggests that inflammatory response plays a vital role in severe CVT pathogenesis and is strongly associated with a poor prognosis. Hypothesis: To investigate the efficacy and safety of steroids combined with anticoagulant therapy in acute/subacute severe CVT patients. Methods: Patients with first-episode acute/subacute CVT between January 2018 and June 2021 were enrolled. We retrospectively reviewed data of patients with acute/subacute severe CVT treated with and without 500mg methylprednisolone pulse therapy for 3 days. We compared functional outcomes and major adverse events 6 months after discharge between two groups using propensity score matching for the purpose of completion. Results: In this study, 248 patients with acute/subacute severe CVT were included, and 93 (37.50%) patients with severe CVT were treated with steroids. After propensity score matching, there were 85 patients each in the steroid and nonsteroid groups. Patients in the steroid group had lower mRS scores (0-2) (P=0.03) and a lower likelihood of residual headache (19.28% vs. 47.50%, P<0.01) than patients in the nonsteroid group at the 6-month follow-up after discharge. Regarding steroid safety, the likelihood of CVT recurrence (6.02% vs. 6.25%, P=0.95), lower extremity deep venous thrombosis (3.61% vs. 1.25%, P=0.33), pulmonary embolism (1.20% vs. 1.25%, P=0.98), infection (1.20% vs. 1.25%, P=0.98), and mortality (2.35% vs. 5.88%, P=0.25) did not differ between both groups. Steroid treatment (OR: 4.685, 95% CI: 1.629-13.476, P=0.00) was independently associated with favorable outcomes in the matched cohort. During the follow-up period, patients treated with steroids did not experience spontaneous fractures, osteonecrosis, or gastroduodenal ulcers. Discussion: Steroid pulse therapy combined with anticoagulant therapy may be effective and safe for improving the prognosis of patients with acute/subacute severe CVT. These findings shed light on the potential ameliorative effects of anti-inflammatory treatments in acute/subacute severe CVT.