Rivaroxaban for the treatment of cerebral venous thrombosis

Sara Esmaeili,Zahra Mirzaasgari,Mohammad Mojtahed,Meysam Abolmaali,Samira Chaibakhsh,Mohammad Reza Motamed,Mohammad Taghi Joghataei,Sobhan Aarabi

doi:10.1186/s12883-021-02091-1

Abstract

BackgroundNew Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk. There is a lack of evidence on the effectiveness and safety of Rivaroxaban in Cerebral venous thrombosis (CVT). This study aims to assess the effectiveness and bleeding risk of Rivaroxaban in comparison with Warfarin for the treatment of CVT.Materials and methods36 patients with diagnosis of CVT were included. Clinical and background information was assessed on admission and patients were followed for at least 12 months. Measured outcomes were modified Rankin Scale (mRS), evidence of recanalization on contrast-enhanced Brain MR venography (MRV) and major or minor bleeding. Patients were divided into two groups according to the type of oral anticoagulant (Rivaroxaban vs Warfarin). Groups were compared in terms of final outcomes and side effects.ResultOverall, 13 (36.11%) patients received Warfarin and 23 (63.89%) received Rivaroxaban. Optimal mRS score (0–1) was attained in 9 of 10 (90%) of patients treated with Rivaroxaban and 19 of 22 (86.36%) of patients received Warfarin. MRV showed complete or partial recanalization in 12 of 14 (85.71%) patients treated with Rivaroxaban and all patients in the Warfarin group. There was no significant difference between the two groups in terms of major and minor hemorrhage.ConclusionRivaroxaban holds promise for the treatment of CVT.

Highlights

New Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk
Optimal modified Rankin Scale (mRS) score (0–1) was attained in 9 of 10 (90%) of patients treated with Rivaroxaban and 19 of 22 (86.36%) of patients received Warfarin
Novel Oral Anticoagulants (NOACs) such as Rivaroxaban might offer a convenient alternative to Warfarin in some thrombotic and thromboembolic disorders [7, 8] Some evidence shows that NOACs generally reduce the potential risks of major and fatal hemorrhages, the major adverse event of Esmaeili et al BMC Neurology (2021) 21:73 anticoagulant drugs, compared to vitamin-K antagonists [9,10,11]

Summary

Introduction

New Oral Anticoagulants (NOACs) such as Rivaroxaban are introduced as alternatives to conventional vitamin-K antagonists in the long-term treatment of thrombotic events due to their lower bleeding risk. This study aims to assess the effectiveness and bleeding risk of Rivaroxaban in comparison with Warfarin for the treatment of CVT. Novel Oral Anticoagulants (NOACs) such as Rivaroxaban might offer a convenient alternative to Warfarin in some thrombotic and thromboembolic disorders [7, 8] Some evidence shows that NOACs generally reduce the potential risks of major and fatal hemorrhages, the major adverse event of Esmaeili et al BMC Neurology (2021) 21:73 anticoagulant drugs, compared to vitamin-K antagonists [9,10,11]. A few reports have addressed this issue; they show similar clinical efficacy of factor Xa inhibitors to Warfarin for CVT treatment and reduced risk for complications [14,15,16]. Ongoing RCT studies comparing Rivaroxaban and Warfarin are underway (NCT03178864, and NCT04569279)

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