Abstract
Available knowledge about the impact of anticoagulation delay on outcomes of patients with cerebral venous thrombosis (CVT) is limited. We therefore assessed the factors influencing anticoagulation delay and investigated the effect of this delay on outcomes of CVT patients. Anticoagulation delay was defined as the time interval between symptom onset and anticoagulation initiation. The primary outcome was a modified Rankin Scale (mRS) score > 2 at the final follow-up. A total of 164 eligible patients were included. The median anticoagulation delay was 9 days. Cerebral hemorrhage on admission neuroimaging correlated with earlier anticoagulation (p = 0.040). Anticoagulation delay was not associated with poor functional outcome (mRS > 2), but it was associated with residual headache across the entire cohort (earlier anticoagulation: 15/76 [19.7%] vs. later anticoagulation: 28/79 [35.4%]; p = 0.029) and in the subgroup with isolated intracranial hypertension (earlier anticoagulation: 4/25 [16.0%] vs. later anticoagulation: 14/27 [51.9%]; p = 0.007). Anticoagulation delay was found to be common among patients with CVT. Anticoagulation delay was not associated with poor functional outcome, but may have led to an increased risk of residual headache across our entire cohort and in the subgroup with isolated intracranial hypertension.
Highlights
Cerebral venous thrombosis (CVT) is a unique type of cerebrovascular disease that varies greatly in its clinical course and prognosis, from complete recovery to disability or death [1, 2]
We systematically investigated the impact of anticoagulation delay on outcomes of patients with CVT
Anticoagulation delay had no significant effect on long-term functional outcomes in CVT patients
Summary
Cerebral venous thrombosis (CVT) is a unique type of cerebrovascular disease that varies greatly in its clinical course and prognosis, from complete recovery to disability or death [1, 2]. A delay in starting anticoagulation may allow progressive thrombosis, a worsening of clinical status, a more complicated condition, and/or an increased thrombus burden, all of which are detrimental to the outcomes of CVT patients. Delay in admission and diagnosis in CVT has been reported in previous studies [3, 4], but each of them is not equivalent to anticoagulation delay. It may take several days from admission to confirmed diagnosis or anticoagulation, during which time clinical worsening may occur [5, 6]. The effect of anticoagulation delay on residual headache, as one of the most common sequelae specific to CVT, has not been evaluated
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