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Abstract
SummaryAimsThe objective of this study was to evaluate cerebral venous recanalization with magnetic resonance black‐blood thrombus imaging (MRBTI) in patients with cerebral venous thrombosis (CVT) who underwent batroxobin treatment in combination with anticoagulation.MethodsA total of 31 CVT patients were enrolled in this real‐world registry study. The patients were divided into batroxobin (n = 21) and control groups (n = 10). In addition to the same standard anticoagulation as in the control group, patients in the batroxobin group underwent intravenous batroxobin for a total of three times.ResultsIn the batroxobin group compared with the control group, we found better odds of recanalization degree [adjusted OR (95%CI) of 8.10 (1.61‐40.7)] and segment‐stenosis attenuation [adjusted OR (95%CI) of 4.48 (1.69‐11.9)] with batroxobin treatment. We further noted a higher ratio of patients with the attenuation of stenosis [adjusted OR (95%CI) of 26.4 (1.10‐635)]; as well as a higher ratio of segments with stenosis reversion [adjusted OR (95%CI) of 4.52 (1.48‐13.8)]. However, neurological deficits between the two groups showed no statistical difference at 90‐day follow‐up (P > 0.05).ConclusionsBatroxobin may promote venous sinus recanalization and attenuate CVT‐induced stenosis. Further randomized study of this promising drug may be warranted to better delineate the amount of benefit.
Highlights
Anticoagulation is still recommended as the gold standard for Cerebral venous thrombosis (CVT) treatment per guidelines issued by the American Heart Association (AHA) and American Stroke Society (ASA) in 2011, and the European Federation of Neurological Societies (EFNS) in 2017,1,2 the outcomes of CVT still can include deterioration despite aggressive anticoagulation[4,5]; the safety and efficacy of some other interventions of CVT are invasive and typically used when patients fail anticoagulation.[6,7,8,9,10]
When evaluated by magnetic resonance black‐blood thrombus imaging (MRBTI) follow‐up, segment stenosis reversed more profoundly in batroxobin group compared with control [unadjusted odd ratio (OR) (95%CI) of 2.91 (1.25‐6.80), P = 0.01; adjusted OR (95%CI) of 4.48 (1.69‐11.9), P < 0.01]
There were 90.5% (19/21) cases in batroxobin group presenting with stenosis improving ≥30% on the follow‐up MRBTI maps, while only 60.0% (6/10) in control showed stenosis improvement on imaging [unadjusted OR (95%CI) of 6.33 (0.92‐43.6); adjusted OR (95%CI) of 26.4 (1.10‐635)]
Summary
Cerebral venous thrombosis (CVT) is an uncommon subtype of stroke with a highly variable clinical course including life‐threatening deterioration especially with multisinus involvement.[1,2,3] anticoagulation (heparin and warfarin) is still recommended as the gold standard for CVT treatment per guidelines issued by the American Heart Association (AHA) and American Stroke Society (ASA) in 2011, and the European Federation of Neurological Societies (EFNS) in 2017,1,2 the outcomes of CVT still can include deterioration despite aggressive anticoagulation[4,5]; the safety and efficacy of some other interventions (such as systematic and endovascular thrombolysis or mechanical venous thrombectomy) of CVT are invasive and typically used when patients fail anticoagulation.[6,7,8,9,10] Adjunctive noninvasive therapies are needed to increase the efficacy of anticoagulation for CVT. Batroxobin is a thrombin‐like serine protease extracted from Bothrops atrox moojeni venom It is a defibrinogenating agent which is more commonly used on cerebral arterial thrombosis.[11,12,13,14,15] A recent study revealed that batroxobin in combination with anticoagulation may be safe and effective for reducing fibrinogen in cerebral venous circulation and promoting thrombolysis.[16] The authors of the previous study utilized time‐of‐flight magnetic resonance venography (TOF MRV) in patients who underwent intravenous batroxobin plus anticoagulation,[16] the study identified batroxobin as a promising agent in CVT control. With the help of MRBTI technique, we aimed to further evaluate the efficacy of batroxobin on promoting CVT recanalization
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