Abstract Body: Background: Newer Oral Anticoagulants (NOACs) offer potential advantages for patients with cerebral venous sinus thrombosis (CVST). However, there is a lack of evidence to evaluate the efficacy and safety of NOACs in CVST. The purpose of this study was to compare the benefit and safety between NOACs and warfarin in CVST patients based on propensity score matching.
Methods: We performed a single-center prospective analysis including CVST patients from the First Affiliated Hospital of Zhengzhou University between January 1, 2018 and December 31, 2021. The primary outcome was recurrent thrombotic events during 6-month follow-up. Secondary outcomes included modified Rankin Scale (mRS), bleeding events, death and cerebral venous recanalization during anticoagulant therapy. Propensity score matching (PSM) was used to balance baseline bias.
Results: A total of 650 patients were identified. NOACs were treated in 184 patients and 466 were used warfarin following hospitalization. After 1:2 and 1:3 PSM, there were no statistically significant differences between the two groups in recurrent CVST (odd ratio [OR], 0.543; 95% CI, 0.258-1.143; P=0.108), bleeding events (OR, 0.823; 95% CI, 0.074-9.143; P=0.874) and partial/complete recanalization (OR, 0.980; 95% CI, 0.546-1.760; P=0.946) in all patients. Similarly, there were no significant differences in patients received anticoagulation therapy group and patients who were performed endovascular therapy plus anticoagulation therapy regarding any of the clinical outcomes. However, there were a statistically significant differences between the two groups in death (2.2% vs 8.0%, P=0.014) and mRS≤2 (95.1% vs 88.7%, P=0.020) in all patients.
Conclusions: Our study demonstrates that the use of NOACs in CVST has similar efficacy and safety compared to warfarin treatment. NOACs treatment may reduced mortality at six months and good functional outcome compared with warfarin.
Keywords: new oral anticoagulants; cerebral venous sinus thrombosis; warfarin; propensity score matching