PB0449 - Direct oral anticoagulants in the management of cerebral sinus vein thrombosis: A single centre experience

Background: Cerebral sinus vein thrombosis accounts for up to 1% of strokes. Anticoagulation is largely adopted as part of management and whilst direct oral anticoagulants (DOACs) are now first line in venous thromboembolism (VTE), there is limited data on efficacy in CSVT.

Aims: We conducted a single centre retrospective observational study reviewing the use of DOACs in patients with CSVT.

Methods: We identified patients with CSVT managed at Guys and St. Thomas’ NHS Foundation Trust between May 2016 and April 2021 by screening CT and MRI reports for keywords associated with a diagnosis of CSVT. Electronic patient records were reviewed to identify patient demographics and management.

Results: 30 adult patients with a diagnosis of CSVT were identified (table 1). Four patients were transferred to other trusts for neurosurgical management or were out of area and are therefore excluded from the review of subsequent anticoagulation management.

23/26 (88%) patients received anticoagulation. Three patients were not anticoagulated (two chronic thrombosis at diagnosis and one thrombotic thrombocytopenic purpura). 78% received initial anticoagulation with a DOAC or were later converted to a DOAC from heparin or warfarin. 80% (16/20) continued on longterm anticoagulation and in 15/16 this was with a DOAC (2/15 dabigatran, 5/15 apixaban, 5/15 rivaroxaban, 3/15 edoxaban).

Two patients had clot extension: one on warfarin, one on a DOAC with an uncontrolled myeloproliferative neoplasm. One patient had a major bleed (subdural requiring intervention once on warfarin then on rivaroxaban 20mg therefore changed to apixaban 2.5mg BD longterm); two patients had minor bleeding with menorrhagia on a DOAC.

Conclusion(s): This small study supports the efficacy and safety of DOACs in the management of CSVT and provides the option for secondary prophylaxis for those requiring longterm anticoagulation. Future directions would include larger studies to assess outcomes for those anticoagulated with DOACS.